Related Experiment Video

Updated: Mar 7, 2026

Breathing-controlled Electrical Stimulation BreEStim for Management of Neuropathic Pain and Spasticity

Breathing-controlled Electrical Stimulation BreEStim for Management of Neuropathic Pain and Spasticity

Published on: January 10, 2013

Opioid-associated modulation of respiratory-related cortical activity in dyspnoeic mechanically ventilated patients:

Suela Demiri^1,2, Xavier Navarro-Suné¹, Marie-Cécile Niérat¹

¹Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France.

Annals of Intensive Care

|March 6, 2026

Abstract

Background:

Dyspnoea is frequent in mechanically ventilated patients and contributes to substantial distress and a heightened risk of post-traumatic stress disorder. It attests to respiratory-related brain suffering that must be actively managed. This is particularly challenging in noncommunicative patients, hence the interest of electroencephalographic surrogates. This study aims at characterizing the effects of opioids, proposed to relieve dyspnoea, on respiratory-related cortical activity in mechanically ventilated patients.

Methods:

In a 16-bed intensive care unit (ICU) over a 4-month period, we consecutively included eighteen mechanically ventilated patients with self-reported dyspnoea (visual analog scale -VAS-, communicative patients) or an observation-derived suspicion of respiratory-related brain suffering (noncommunicative patients, respiratory distress observation scores -RDOS-) persisting despite ventilator settings optimisation. Participants underwent electroencephalographic (EEG) recordings before and after administration of intravenous opioids. Respiratory-related cortical activity was assessed using covariance-based connectivity analysis, preinspiratory potentials (PIPs), and time-frequency analysis (TFA) time-locked to inspiration. To disentangle respiratory-specific from general effects of opioids, TFA was also computed from randomly selected EEG segments.

Results:

Opioids reduced dyspnoea evaluated by VAS and RDOS without significant sedation. EEG covariance analysis showed changes in brain state in 15 of 18 patients. PIP occurrence was variable and not modulated by opioids. TFA revealed statistically significant opioid-induced modulations in low beta and high beta power bands time-locked to inspiration, not observed in randomly timed analyses hence a specific effect of opioids on respiratory-related cortical networks.

Conclusion:

Opioids can relieve dyspnoea in mechanically ventilated ICU patients and modulate respiratory-related cortical activity beyond their general effects on cortical electrogenesis. This suggests that their effects on breathing control are not limited to brainstem mechanisms.

Keywords:

Dyspnoea Electroencephalogram Mechanical ventilation Opioids Respiratory-related brain suffering

More Related Videos

Acquisition and Semi-Automated Analysis of Respiratory Muscle Surface Electromyography

Acquisition and Semi-Automated Analysis of Respiratory Muscle Surface Electromyography

Published on: January 24, 2025

Electrophysiology on Isolated Brainstem-spinal Cord Preparations from Newborn Rodents Allows Neural Respiratory Network Output Recording

Electrophysiology on Isolated Brainstem-spinal Cord Preparations from Newborn Rodents Allows Neural Respiratory Network Output Recording

Published on: November 19, 2015

Related Concept Videos

Physiological Control of Respiration

Physiological Control of Respiration

Introduction
Breathing, a seemingly passive process, is regulated by the respiratory center in the brainstem. This center coordinates the involuntary control of respirations, which means it occurs without conscious effort, ensuring a smooth and uninterrupted pattern.
Regulation of Ventilation
The body maintains ventilation by monitoring levels of carbon dioxide (CO2), oxygen (O2), and hydrogen ion concentration (pH) in the arterial blood. Among these factors, the level of CO2 plays a crucial...

Acute Respiratory Failure-IV

Acute Respiratory Failure-IV

Respiratory failure can manifest suddenly or gradually, characterized by a rapid decline in PaO2 and a rapid rise in PaCO2. This situation indicates a severe respiratory problem that may quickly become a life-threatening emergency. One of the early signs of hypoxemic Acute Respiratory Failure (ARF) is a change in mental status due to the brain's sensitivity to oxygen levels and changes in acid-base balance. Symptoms such as restlessness, confusion, and agitation suggest inadequate oxygen...

Alterations in Respiration II

Alterations in Respiration II

There are numerous types of normal and abnormal respiration. Based on ventilatory movements, breathing patterns are classified as regular, deep, or shallow. Examples include Biot's breathing, Cheyne-Stokes respiration, Kussmaul's breathing, hyperventilation, and hypoventilation. Each pattern is clinically significant and aids in evaluating patients.
In Biot's breathing, the respiratory rate and depth are irregular, alternating between periods of deep gasping and apnea. Common causes...

Acute Respiratory Failure-III

Acute Respiratory Failure-III

Hypercapnic respiratory failure, also known as Type 2 or ventilatory respiratory failure, is a severe condition characterized by the body's inability to effectively remove carbon dioxide (CO2) from the bloodstream. It leads to an arterial CO2 pressure (PaCO2) exceeding 45 mmHg and a blood pH above 7.35. This situation indicates that the body's ventilatory demand, or the ventilation needed to maintain normal PaCO2 levels, surpasses its supply or the maximum gas flow achievable without...

Respiratory Volumes and Capacities I

Respiratory Volumes and Capacities I

Assessing the respiratory rate and rhythm for a complete minute is crucial for evaluating the breathing pattern. Even a minor increase in the patient's average respiratory rate, by as little as three to five breaths per minute, is an early and vital indicator of respiratory distress. Patients with a respiratory rate exceeding twenty-four breaths per minute require close monitoring to determine the physiological alterations. This careful observation is essential for prompt recognition and...

Physiology of Respiration II: Neurogenic Control of Respiration

Physiology of Respiration II: Neurogenic Control of Respiration

The neurogenic control of respiration coordinates various neural networks and pathways to regulate breathing rate and depth, meeting the body's oxygen and carbon dioxide exchange requirements. This system adapts to physiological and environmental conditions, ensuring optimal breathing patterns.
Central Control
The brainstem is the primary site of central control, hosting respiratory centers:

Articles linked to this work by shared authors, journal, and citation graph.

Immune clinical profiles as determinants of acute respiratory failure etiologies in critically ill patients with hematological malignancies: A multicenter analysis.

Journal of critical care·2026

Impact of a strategy using multiplex PCR on targeted antibiotic therapy for patients with suspected ventilator-associated pneumonia or hospital-acquired pneumonia requiring mechanical ventilation: a randomized, single-blind trial.

Intensive care medicine·2026

Early red blood cell transfusion strategy in septic shock among patients with cancer: the TRANSPORT randomized controlled trial.

Intensive care medicine·2026

Hallmarks of Weaning From Mechanical Ventilation: A 3S Framework for Ventilator Liberation-A Narrative Review.

Chest·2026

Plasma endocan and cleaved endocan for the diagnosis of microbiologically confirmed ventilator-associated pneumonia in intensive care patients.

Scientific reports·2026

Impact of a Mechanical Insufflator-Exsufflation on the Need for Tracheal Suctioning in Intubated Patients.

Respiratory care·2026

See all related articles