Hello,
I recently published a short proposal about the health promoting effects of six per minute non-invasive ventilation, founded on over 30 years of clinical research in HRV biofeedback:Research Proposal Six per minute non-invasive ventilation: Resonant Frequency ...
I would love to hear from clinicians about this idea, and collaborate with any interested parties. Thanks!
Abstract:
Controlled respiration near six breaths per minute creates a balanced respiratory cycle that strongly flexes the autonomic system between parasympathetic and sympathetic with each breath -- baroreflex circuit resonance drives maximum respiratory sinus arrhythmia (i.e. vagal-associated HRV) which strongly oscillates vascular tone, heart rate, and blood pressure. This perfect balance of relaxation and alertness recharges the homeostatic function, optimizes neurovisceral integration, promotes efficient pulmonary gas exchange, reduces pain perception, stimulates anti-inflammatory reflexes, and enhances resilience to physical and emotional stressors. Therefore I propose the study of six per minute ventilation on COVID-19 patients, delivered non-invasively through BiPAP S/T, to promote beneficial neuromodulation against vascular and immuno-inflammatory complications.
What about hypercarbia? Will the arterial blood gas level and parameters be within the normal limits?
thanks for your question! I do not know yet, this is why I need critical input and collaborative dialogue from clinicians like you. If CO2 levels get too high the respiration rate could be easily increased to normalize blood gases. It is likely that 2-3 short periods of 10-15 minutes of 6 per minute respiration daily will be sufficient for preventative neuromodulation.
I forgot to mention that in the practice of biofeedback this frequency of breathing is only done for 10-30 minutes. So a long period would not be necessary, just a few short sessions per day. I have clarified this in a v2 draft.
If it is periodical and yields significant benefits then it may be adopted under vigilant monitoring, and of course, in selective patients where it is clearly indicated and feasible. Needs more experts opinions.
Non-invasive ventilation is aerosol generating and so increases risk to healthcare professionals of acquiring SARS-CoV-2 infection. So use must be very carefully considered.
Rajkumar Rajendram good point. The airflow output can be HEPA filtered, as shown here https://www.youtube.com/watch?v=xC6LRNm7CAU. I will make this clear in my next draft update.
Tahir Ali Thanks, I'm not a clinician so this is still hypothetical and I am learning about the details of actual care. I suppose this RF breathing would be most relevant for preventing decline in early cases (a nurse colleague used the term "happy hypoxics"). Following along with an auditory soundtrack is an even simpler method, for such patients that have not progressed to complications.
My understanding is that tachypnea is indicative of sympathetic overdrive, and that finding a way to reduce the respiratory rate would balance the autonomic system into a more resourced and resilient state for recovery (i.e. autopoietic homeostasis, self-healing, or metabolism balanced between catabolism and anabolism). Respiration at 6 per minute is the zone of perfect sympathovagal balance and energy efficiency, neither relaxation nor fight-or-flight.
Would it be possible for such a patient to consciously reduce their respiratory rate for short periods? As a last resort, would mild sedation be a possibility to reduce respiratory rate without without causing harm?
May be it can helps / fisiophatology of pulmonary arteries.
Can we manage prophylactic therapy in COVID-19 patients to prevent severe illness complications? -RG publication
Many patients with COVID-19 have thromboembolic complications that worsen their prognosis. Herein, the authors propose a modified version of the CHA 2 DS 2-VASc score, including 1 point for COVID-19, so that prophylaxis to protect against thromboembolic events would be indicated before the condition becomes severe. The advantages of this modification would be prevention of the patient' s condition worsening due to thromboembolic problems and reduction of the likelihood of a need for intensive care and mechanical ventilation, reducing mortality.
non invasive ventilation with someone who has Covid-19 would only be considered in type 2 respiratory failure. For these patients, who generally present with type 1 respiratory failure, CPAP would be the preferred mode of ventilation. Plus, it is very difficult for a patient who is air hungry and short of breath, to moderate their respiratory rate in the way you are suggesting. Oxygenation is paramount in these very sick patients.
Thanks for your reply Paul. It seems that this intervention may be most useful as an preventative measure for those at high risk. Especially since the benefits of RF breathing are helpful for the primary conditions in the first place (hypertension, asthma, etc).
I have an idea for a medical device that modulates the baroreflex by sinusoidal neck pressure, bypassing the need for breath modulation. Such a passive device would likely be more practical in acute care.