Objective: Aim of the study;  to investigate if apomorphine might  facilitate weaning from mechanical ventilation in parkinsonian patients.

Background: Apomorphine is an effective treatment for PD patients with disabling motor fluctuations. The effect of apomorphine on respiratory function in PD has been less explored. Previously, we showed that the ability to perform maximal volitional respiratory manoeuvers improved significantly on apomorphine Treatment (1). Weaning PD-patients from mechanical ventilation can be very difficult due to insufficient respiratory drive and poor performance of the respiratory muscle pump. Therefore, we considered to use apomorphine to support the weaning process.

Method: Methods: Apomorphine was administered 10 (6 female, 4male, mean age: 64.5 + 5.1years) PD-patients during weaning from the ventilator. Reasons for mechanical ventilation included pneumonia with subsequent severe septicaemia (4 patients), respiratory failure due to exacerbated chronic obstructive pulmonary disorder (COPD) (3 patients) and severe akinesia with respiratory failure (3 patients). All patients got levodopa via nasogastric feeding tube,  7 of 10 had rotigotine patches. Periods with assisted ventilation alternated with active weaning periods according to a weaning protocol. After failure of the standard weaning concept we started treatment with repeated apomorphine injections (mean dosage 4,2mg) via pen prior to active weaning periods.

Results: Reasons for failure of mechanical weaning were insufficient tidal volume (4 patients), insufficient respiratory drive (3 patients), discoordination of respiratory muscles (2patients) and general akinesia (1patient).The patients had up to 5 injections of apomorphine per day. 5 patients were extubated within 2 days after begin of apomorphine injections and continued on 2-3 apomorphine injections for the next 4 days, The other patients showed only short lasting response to apomorphine injections and went on apomorphine infusions (16 h/d). The flowrate ranged from 4 – 6.5 mg/h. Within 3 days after start of apomorphine infusions all patients were extubated. Apomorphine s.c. infusions were continued for further 7 days to support coughing and breathing manoeuvers.

Conclusion: Conclusion: Apomorphine facilitated weaning from mechanical ventilation in PD-patients by improving respiratory drive and performance of respiratory muscle pump. Thus, use of apomorphine should be considered in PD patients in ICU.

References: (1) Lyall RA, Reuter I, Mills J. et al. Effects of acute subcutaneous apomorphine on respiratory muscle strength in Parkinson disease.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/apomorphine-improves-pulmonary-function-in-parkinsonian-patients/