BACKGROUND Ataxic breathing (AB) is a well-known manifestation of opioid effects in animals and humans, but is not routinely included in monitoring for opioid-induced respiratory depression (OIRD). We quantified AB in normal volunteers receiving increasing doses of remifentanil. We used a support vector machine (SVM) learning approach with features derived from a modified Poincaré plot. We tested the hypothesis that AB may be found when bradypnea and reduced mental status are not present. METHODS Twenty-six healthy volunteers (13 female) received escalating target effect-site concentrations of remifentanil with a low baseline dose of propofol to simulate typical breathing patterns in drowsy patients who had received parenteral opioids. We derived respiratory rate (RR) from respiratory inductance plethysmography, mental alertness from the Modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S), and AB severity on a 0 to 4 scale (categories ranging from none to severe) from the SVM. The primary outcome measure was sensitivity and specificity for AB to detect OIRD. RESULTS All respiratory measurements were obtained from unperturbed subjects during steady state in 121 assessments with complete data. The sensitivity of AB for detecting OIRD by the conventional method was 92% and specificity was 28%. As expected, 69 (72%) of the instances not diagnosed as OIRD using conventional measures were observed to have at least moderate AB. CONCLUSIONS AB was frequently present in the absence of traditionally detected OIRD as defined by reduced mental alertness (MOAA/S score of <4) and bradypnea (RR <8 breaths/min). These results justify the need for future trials to explore replicability with other opioids and clinical utility of AB as an add-on measure in recognizing OIRD.

中文翻译：

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定量共济失调呼吸可以在注射瑞芬太尼的正常志愿者中更早地检测出阿片类药物引起的呼吸抑制。


背景共济失调呼吸（AB）是阿片类药物作用在动物和人类中的众所周知的表现，但通常不包括在阿片类药物引起的呼吸抑制（OIRD）的监测中。我们对接受瑞芬太尼剂量增加的正常志愿者的 AB 进行了量化。我们使用支持向量机 (SVM) 学习方法，其特征源自修改后的庞加莱图。我们检验了以下假设：当不存在呼吸缓慢和精神状态下降时，可能会发现 AB。方法 26 名健康志愿者（13 名女性）接受瑞芬太尼目标效应部位浓度逐渐升高的治疗，并使用低基线剂量的丙泊酚，以模拟接受肠外阿片类药物治疗的昏昏欲睡患者的典型呼吸模式。我们从呼吸电感体积描记法中得出呼吸频率 (RR)，从改良观察者警觉性/镇静量表评估 (MOAA/S) 中得出精神警觉性，并从 SVM 中得出 0 到 4 级的 AB 严重程度（类别范围从无到严重） 。主要结果指标是 AB 检测 OIRD 的敏感性和特异性。结果 所有呼吸测量值均来自未受干扰的受试者，在 121 项评估的稳定状态下获得完整数据。常规方法AB检测OIRD的敏感性为92%，特异性为28%。正如预期的那样，在使用常规方法未诊断为 OIRD 的病例中，有 69 例 (72%) 被观察到至少具有中度 AB。结论 AB 经常出现在没有传统检测到的 OIRD 的情况下，OIRD 的定义是精神警觉性降低（MOAA/S 评分 <4）和呼吸缓慢（RR <8 次呼吸/分钟）。这些结果证明未来需要进行试验来探索其他阿片类药物的可复制性以及 AB 作为识别 OIRD 的附加措施的临床实用性。