Effect of inspiratory flow rate on respiratory rate in intubated ventilated patients

It has previously been demonstrated that in normal subjects using a volume-cycled ventilator, increasing inspiratory flow rate increases respiratory rate. We undertook the current study to determine (1) whether this effect is also present in patients with respiratory disease and (2) whether the effect is independent of upper airway receptors. Eight ventilator-dependent patients in the intensive care unit were studied. Patients were ventilated in the assist-control mode with the back-up rate set at 0.5 breaths/min to ensure that all breaths were patient-triggered. While tidal volume was held constant, flow was changed from a baseline flow of 60 L/min. Trials involved changing flow to either 30 or 90 L/min. There was a significant decrease in respiratory rate (-3.4 +/- 0.6 min-1, p < 0.001) when flow was decreased from 60 to 30 L/min. There was a significant increase in respiratory rate (2.3 +/- 0.8 min-1, p < 0.05) when flow was increased from 60 to 90 L/min. As a result of the change in respiratory rate, TE (expiratory time) showed a variable response to changes in flow rate, with some patients actually demonstrating a reduced TE with higher flow rates. No patients experienced the increase in TE that would have been predicted without a change in respiratory rate. We conclude that in intubated ventilated patients, spontaneous respiratory rate is sensitive to inspiratory flow rate. This effect appears to be independent of upper airway receptors, since it was observed with a by-passed upper airway. The increase in respiratory rate seen at higher flow rates undermines attempts to increase TE by increasing flow rates. It may also cause a tendency toward respiratory alkalosis.