TY - JOUR
T1 - Effect of decreasing respiratory rate on the mechanical power of ventilation and lung injury biomarkers
T2 - a randomized cross-over clinical study in COVID-19 ARDS patients
AU - Damiani, L. Felipe
AU - Basoalto, Roque
AU - Oviedo, Vanessa
AU - Alegria, Leyla
AU - Soto, Dagoberto
AU - Bachmann, M. Consuelo
AU - Jalil, Yorschua
AU - Santis, Cesar
AU - Carpio, David
AU - Ulloa, Rodrigo
AU - Valenzuela, Daniel
AU - Vera, Magdalena
AU - Schultz, Marcus J.
AU - Retamal, Jaime
AU - Bruhn, Alejandro
AU - Bugedo, Guillermo
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2025/12
Y1 - 2025/12
N2 - Background: The respiratory rate (RR) is a key determinant of the mechanical power of ventilation (MP). The effect of reducing the RR on MP and its potential to mitigate ventilator-induced lung injury remains unclear. Objectives: To compare invasive ventilation using a lower versus a higher RR with respect to MP and plasma biomarkers of lung injury in COVID-19 ARDS patients. Methods: In a randomized cross-over clinical study in COVID-19 ARDS patients, we compared ventilation using a lower versus a higher RR in time blocks of 12 h. Patients were ventilated with tidal volumes of 6 ml/kg predicted body weight, and positive-end-expiratory pressure and fraction of inspired oxygen according to an ARDS network table. Respiratory mechanics and hemodynamics were assessed at the end of each period, and blood samples were drawn for measurements of inflammatory cytokines, epithelial and endothelial lung injury markers. In a subgroup of patients, we performed echocardiography and esophageal pressure measurements. Results: We enrolled a total of 32 patients (26 males [81%], aged 52 [44–64] years). The median respiratory rate during ventilation with a lower and a higher RR was 20 [16–22] vs. 30 [26–32] breaths/min (p < 0.001), associated with a lower median minute ventilation (7.3 [6.5–8.5] vs. 11.6 [10–13] L/min [p < 0.001]) and a lower median MP (15 [11–18] vs. 25 [21–32] J/min [p < 0.001]). No differences were observed in any inflammatory (IL-6, IL-8, and TNF-R1), epithelial (s-RAGE and SP-D), endothelial (Angiopoietin-2), or pro-fibrotic activity (TGF-ß) marker between high or low RR. Cardiac function by echocardiography, and respiratory mechanics using esophageal pressure measurements were also not different. Conclusions: Reducing the respiratory rate decreases mechanical power in COVID-19 ARDS patients but does not reduce plasma lung injury biomarkers levels in this cross-over study. Study registration This study is registered at clinicaltrials.gov
AB - Background: The respiratory rate (RR) is a key determinant of the mechanical power of ventilation (MP). The effect of reducing the RR on MP and its potential to mitigate ventilator-induced lung injury remains unclear. Objectives: To compare invasive ventilation using a lower versus a higher RR with respect to MP and plasma biomarkers of lung injury in COVID-19 ARDS patients. Methods: In a randomized cross-over clinical study in COVID-19 ARDS patients, we compared ventilation using a lower versus a higher RR in time blocks of 12 h. Patients were ventilated with tidal volumes of 6 ml/kg predicted body weight, and positive-end-expiratory pressure and fraction of inspired oxygen according to an ARDS network table. Respiratory mechanics and hemodynamics were assessed at the end of each period, and blood samples were drawn for measurements of inflammatory cytokines, epithelial and endothelial lung injury markers. In a subgroup of patients, we performed echocardiography and esophageal pressure measurements. Results: We enrolled a total of 32 patients (26 males [81%], aged 52 [44–64] years). The median respiratory rate during ventilation with a lower and a higher RR was 20 [16–22] vs. 30 [26–32] breaths/min (p < 0.001), associated with a lower median minute ventilation (7.3 [6.5–8.5] vs. 11.6 [10–13] L/min [p < 0.001]) and a lower median MP (15 [11–18] vs. 25 [21–32] J/min [p < 0.001]). No differences were observed in any inflammatory (IL-6, IL-8, and TNF-R1), epithelial (s-RAGE and SP-D), endothelial (Angiopoietin-2), or pro-fibrotic activity (TGF-ß) marker between high or low RR. Cardiac function by echocardiography, and respiratory mechanics using esophageal pressure measurements were also not different. Conclusions: Reducing the respiratory rate decreases mechanical power in COVID-19 ARDS patients but does not reduce plasma lung injury biomarkers levels in this cross-over study. Study registration This study is registered at clinicaltrials.gov
KW - ARDS
KW - Invasive ventilation
KW - Lung injury biomarkers
KW - MP
KW - Mechanical power of ventilation
KW - Respiratory rate
KW - VILI
KW - Ventilator-induced lung injury
UR - https://www.scopus.com/pages/publications/105010337886
U2 - 10.1186/s40635-025-00782-4
DO - 10.1186/s40635-025-00782-4
M3 - Article
AN - SCOPUS:105010337886
SN - 2197-425X
VL - 13
JO - Intensive Care Medicine Experimental
JF - Intensive Care Medicine Experimental
IS - 1
M1 - 69
ER -