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Can donepezil facilitate weaning from mechanical ventilation in difficult to wean patients? An interventional pilot study.

Abbasi S, Farsaei S, Fazel K, Golzari SE, Mahmoodpoor A - Daru (2015)

Bottom Line: Twelve out of 16 studied patients experienced successful results to facilitate weaning with donepezil intervention.Our results in the clinical setting suggest that, the use of donepezil can expedite weaning presumably by stimulation of respiratory center and obviate the need to re-intubation in cases of respiratory drive problem in difficult to wean patients.We suggest decrease PCO2 and HCO3 during donepezil steady could be valuable predictors for positive response to donepezil intervention.

View Article: PubMed Central - PubMed

Affiliation: Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. s_abbasi@med.mui.ac.ir.

ABSTRACT

Background: Management of difficult to wean patients is a dilemma for health care system. Recently published studies demonstrated efficacy of donepezil to counteract respiratory depression in sleep apnea. However, to the best of our knowledge, pharmaceutical interventions with donepezil to facilitate weaning have not been tested so far. Therefore in the present study, we evaluated the efficacy of using donepezil on weaning course in difficult to wean patients.

Methods: In this non-randomized interventional clinical study, difficult to wean patients with prior inappropriately depressed respiratory responses were included from two referral intensive care units (ICU) in Iran. Patients with another potentially reasons of weaning failure were excluded from the study. Donepezil was started for eligible patients at dose of 10 mg daily for 2-4 weeks. For the primary outcomes, arterial blood gas (ABG) parameters were also measured before and after intervention to evaluate the possible effects of donepezil on them. In addition, weaning outcomes of patients were reported as final outcome in response to this intervention.

Results: Twelve out of 16 studied patients experienced successful results to facilitate weaning with donepezil intervention. The mean duration of donepezil treatment until outcome measurement was 12 days. There were not any significant differences in ABG parameters among patients with successful and failed weaning trial on day of donepezil initiation. However after donepezil intervention, mean of PCO2 and HCO3 decreased in patients with successful weaning trial and mean of PCO2 increased in those with weaning failure.

Conclusions: Reduced central respiratory drive was infrequently reason of failed weaning attempts but it must be considered especially in patients with hypercapnia secondary to inefficient gas exchange and slow breathing. Our results in the clinical setting suggest that, the use of donepezil can expedite weaning presumably by stimulation of respiratory center and obviate the need to re-intubation in cases of respiratory drive problem in difficult to wean patients. We suggest decrease PCO2 and HCO3 during donepezil steady could be valuable predictors for positive response to donepezil intervention.

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Related in: MedlinePlus

Variation of Arterial blood gas during donepezil treatment. Variations in arterial PH, PO2, PCO2, HCO3 and oxygen saturation were demonstrated in part A, B, C, D and E respectively. For each patient the first reported parameter was related to donepezil initiation day and the last one demonstrated that parameter on weaning day or until donepezil treatment was continued in cases of weaning failure. Patients with number 5, 11, 14 and 16 had unsuccessful attempts for weaning.
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Fig2: Variation of Arterial blood gas during donepezil treatment. Variations in arterial PH, PO2, PCO2, HCO3 and oxygen saturation were demonstrated in part A, B, C, D and E respectively. For each patient the first reported parameter was related to donepezil initiation day and the last one demonstrated that parameter on weaning day or until donepezil treatment was continued in cases of weaning failure. Patients with number 5, 11, 14 and 16 had unsuccessful attempts for weaning.

Mentions: The effects of donepezil on arterial blood gas (ABG) were also evaluated on day of donepezil initiation and on day of outcome measurement. Variations in arterial PH, PO2, PCO2, HCO3 and oxygen saturation were demonstrated in part A, B, C, D and E of FigureĀ 2 respectively. Results showed patients had no evidence of primary metabolic alkalosis at weaning time.Figure 2


Can donepezil facilitate weaning from mechanical ventilation in difficult to wean patients? An interventional pilot study.

Abbasi S, Farsaei S, Fazel K, Golzari SE, Mahmoodpoor A - Daru (2015)

Variation of Arterial blood gas during donepezil treatment. Variations in arterial PH, PO2, PCO2, HCO3 and oxygen saturation were demonstrated in part A, B, C, D and E respectively. For each patient the first reported parameter was related to donepezil initiation day and the last one demonstrated that parameter on weaning day or until donepezil treatment was continued in cases of weaning failure. Patients with number 5, 11, 14 and 16 had unsuccessful attempts for weaning.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4374336&req=5

Fig2: Variation of Arterial blood gas during donepezil treatment. Variations in arterial PH, PO2, PCO2, HCO3 and oxygen saturation were demonstrated in part A, B, C, D and E respectively. For each patient the first reported parameter was related to donepezil initiation day and the last one demonstrated that parameter on weaning day or until donepezil treatment was continued in cases of weaning failure. Patients with number 5, 11, 14 and 16 had unsuccessful attempts for weaning.
Mentions: The effects of donepezil on arterial blood gas (ABG) were also evaluated on day of donepezil initiation and on day of outcome measurement. Variations in arterial PH, PO2, PCO2, HCO3 and oxygen saturation were demonstrated in part A, B, C, D and E of FigureĀ 2 respectively. Results showed patients had no evidence of primary metabolic alkalosis at weaning time.Figure 2

Bottom Line: Twelve out of 16 studied patients experienced successful results to facilitate weaning with donepezil intervention.Our results in the clinical setting suggest that, the use of donepezil can expedite weaning presumably by stimulation of respiratory center and obviate the need to re-intubation in cases of respiratory drive problem in difficult to wean patients.We suggest decrease PCO2 and HCO3 during donepezil steady could be valuable predictors for positive response to donepezil intervention.

View Article: PubMed Central - PubMed

Affiliation: Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. s_abbasi@med.mui.ac.ir.

ABSTRACT

Background: Management of difficult to wean patients is a dilemma for health care system. Recently published studies demonstrated efficacy of donepezil to counteract respiratory depression in sleep apnea. However, to the best of our knowledge, pharmaceutical interventions with donepezil to facilitate weaning have not been tested so far. Therefore in the present study, we evaluated the efficacy of using donepezil on weaning course in difficult to wean patients.

Methods: In this non-randomized interventional clinical study, difficult to wean patients with prior inappropriately depressed respiratory responses were included from two referral intensive care units (ICU) in Iran. Patients with another potentially reasons of weaning failure were excluded from the study. Donepezil was started for eligible patients at dose of 10 mg daily for 2-4 weeks. For the primary outcomes, arterial blood gas (ABG) parameters were also measured before and after intervention to evaluate the possible effects of donepezil on them. In addition, weaning outcomes of patients were reported as final outcome in response to this intervention.

Results: Twelve out of 16 studied patients experienced successful results to facilitate weaning with donepezil intervention. The mean duration of donepezil treatment until outcome measurement was 12 days. There were not any significant differences in ABG parameters among patients with successful and failed weaning trial on day of donepezil initiation. However after donepezil intervention, mean of PCO2 and HCO3 decreased in patients with successful weaning trial and mean of PCO2 increased in those with weaning failure.

Conclusions: Reduced central respiratory drive was infrequently reason of failed weaning attempts but it must be considered especially in patients with hypercapnia secondary to inefficient gas exchange and slow breathing. Our results in the clinical setting suggest that, the use of donepezil can expedite weaning presumably by stimulation of respiratory center and obviate the need to re-intubation in cases of respiratory drive problem in difficult to wean patients. We suggest decrease PCO2 and HCO3 during donepezil steady could be valuable predictors for positive response to donepezil intervention.

Show MeSH
Related in: MedlinePlus