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The effects of different weaning modes on the endocrine stress response

Guniz M Koksal1*, Cem Sayilgan1, Oznur Sen2 and Huseyin Oz3

Author Affiliations

1 Senior Resident, Department of Anaesthesiology and Reanimation, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey

2 Resident, Department of Anaesthesiology and Reanimation, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey

3 Professor, Department of Anaesthesiology and Reanimation, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey

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Critical Care 2004, 8:R31-R34 doi:10.1186/cc2413

Published: 3 December 2003

Abstract

Introduction

The aim of the present study was to investigate the effects of the stress response on plasma insulin, cortisol, glucose, and urinary vanilmandelic acid during weaning and after extubation, using pressure support (PS), continuous positive airway pressure (CPAP) and T-piece modes.

Methods

Sixty patients were randomly divided into three groups (n = 20). The PS group received FiO2 ≤ 0.4, PS ≤ 10 cmH2O, and positive end expiratory pressure ≤ 5 cmH2O for 2 hours. The CPAP group was given FiO2 ≤ 0.4 and CPAP 5 ≤ cmH2O for 2 hours. The T-piece group (group T) received 4 l/min oxygen via a T-piece for 2 hours. After 1 hour and 2 hours in their respective weaning modes, blood and urine samples were taken for insulin, cortisol, glucose and vanilmandelic acid measurements. Forty-eight hours after extubation, blood and urine samples were again taken.

Results

Plasma insulin was greater in group T than in the PS and CPAP groups (P < 0.01 and P < 0.01). The plasma cortisol concentration was greater in group T than in group PS during weaning (P < 0.05) and after extubation (P < 0.05). Blood glucose concentrations were greater in group T than in the other groups (both P < 0.01) both during weaning and post extubation. Urine vanilmandelic acid was greater in group T than in the other groups during weaning and after extubation (both P < 0.001).

Conclusion

Weaning via the T-piece caused a greater stress response than the PS and CPAP modes.

Keywords:
cortisol; insulin; mechanical ventilation; stress response; ventilation modes; weaning