Profound bradycardia with decreased PEEP

Susan R. Wilcox, Ankit Kansagra, Jeremy B. Richards

Research output: Contribution to journalArticle

Abstract

An athletic 21-year-old male was admitted to the surgical ICU after sustaining 2 stab wounds to his torso. He had an episode of left lung collapse early in his course, managed with suctioning and increased PEEP, to 15 cm H2O. He was bradycardic (heart rates 50-60 beats/min) throughout his ICU stay, but when the PEEP was lowered to 5 cm H2O in preparation for extubation, he developed sinus pauses and his heart rate dropped to 20 beats/min. After a thorough evaluation, the drop in his heart rate was determined to be due to increased vagal tone from increased cardiac output with the decreased PEEP. After premedication with glycopyrrolate, he was successfully extubated the following day, while his heart rate remained at his baseline of 50 beats/min. We review the physiologic mechanisms of bradycardia due to the removal of mechanical ventilation.

Original languageEnglish (US)
JournalRespiratory Care
Volume58
Issue number11
DOIs
StatePublished - Nov 1 2013

Fingerprint

Bradycardia
Heart Rate
Glycopyrrolate
Stab Wounds
Torso
Pulmonary Atelectasis
Premedication
Artificial Respiration
Cardiac Output
Sports

Keywords

  • Autonomic signaling
  • Bradycardia
  • Cardiovascular reflex
  • Mechanical ventilation
  • Vasovagal reflex

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Profound bradycardia with decreased PEEP. / Wilcox, Susan R.; Kansagra, Ankit; Richards, Jeremy B.

In: Respiratory Care, Vol. 58, No. 11, 01.11.2013.

Research output: Contribution to journalArticle

Wilcox, Susan R. ; Kansagra, Ankit ; Richards, Jeremy B. / Profound bradycardia with decreased PEEP. In: Respiratory Care. 2013 ; Vol. 58, No. 11.
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