Abstract

BackgroundDexmedetomidine can be used for sedation of mechanically ventilated patients and has minor respiratory effects. The aim of this study was to compare the incidence of patient-ventilator dyssynchronies during sedation with dexmedetomidine or propofol.MethodsWe conducted a multicentre, prospective, open-label, randomised clinical trial, comparing dexmedetomidine with standard propofol sedation at three intensive care units of university hospitals in Italy. Twenty difficult-to-wean patients for whom the first weaning trial had failed and who were on pressure support ventilation were randomised to receive sedation with either dexmedetomidine or propofol at a similar level of sedation (Richmond Agitation-Sedation Scale [RASS] score +1 to −2). The asynchrony index (AI) was calculated using tracings of airflow, airway pressure and electrical activity of the diaphragm sampled at 0, 0.5, 1, 2, 6, 12, 18 and 24 h.ResultsThe mean AI was lower with dexmedetomidine than with propofol from 2 h onwards, although the two groups significantly differed only at 12 h (2.68 % vs 9.10 %, p < 0.05). No further difference was observed at 18 and 24 h.ConclusionsWhen sedation with propofol and dexmedetomidine was compared at similar RASS scores of patients in whom first weaning trial had failed, the AI was lower with dexmedetomidine than with propofol, and this difference was statistically significant at 12 h. These results suggest that sedation with dexmedetomidine may offer some advantages in terms of patient-ventilator synchrony.

Highlights

  • Dexmedetomidine can be used for sedation of mechanically ventilated patients and has minor respiratory effects

  • For the purposes of this study, difficulty to wean was determined by failure at a single adequate weaning trial, according to a common weaning protocol based on the progressive reduction of the pressure support (PS) level and ending with a spontaneous breathing trial of 30 minutes at 7 cmH2O of pressure support ventilation (PSV) and positive end-expiratory pressure (PEEP) of 5 cmH2O, using the following standard criteria [17]: 1. Respiratory rate >35 breaths/minute 2

  • This study produced indications that, after optimization of ventilator settings according to clinical response, blood gases and ventilator tracings for the same level of sedation, the asynchrony index (AI) was lower with dexmedetomidine than with propofol

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Summary

Introduction

Dexmedetomidine can be used for sedation of mechanically ventilated patients and has minor respiratory effects. During assisted MV, patient-ventilator interaction is influenced both by machine settings [6, 7] and by the patient’s respiratory pattern, timing and drive [8, 9]. These are directly affected by sedatives, whose effects vary, depending both on the drug used and on the dose administered [10, 11]. Conti et al Critical Care (2016) 20:206 recently, research has shown that sedation with propofol was associated with a reduction in respiratory drive causing significant derangements in patient-ventilator synchrony in ICU patients receiving assisted ventilatory support [9]. That technique enabled an easy computation of the asynchrony index (AI), a metric previously reported to be an independent predictor of longer MV and ICU stay [6]

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