Cargando…

Effects of dexmedetomidine and propofol on patient-ventilator interaction in difficult-to-wean, mechanically ventilated patients: a prospective, open-label, randomised, multicentre study

BACKGROUND: Dexmedetomidine 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. METHODS: We conducted a multicentre, p...

Descripción completa

Detalles Bibliográficos
Autores principales: Conti, Giorgio, Ranieri, Vito Marco, Costa, Roberta, Garratt, Chris, Wighton, Andrew, Spinazzola, Giorgia, Urbino, Rosario, Mascia, Luciana, Ferrone, Giuliano, Pohjanjousi, Pasi, Ferreyra, Gabriela, Antonelli, Massimo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930611/
https://www.ncbi.nlm.nih.gov/pubmed/27368279
http://dx.doi.org/10.1186/s13054-016-1386-2
_version_ 1782440771225387008
author Conti, Giorgio
Ranieri, Vito Marco
Costa, Roberta
Garratt, Chris
Wighton, Andrew
Spinazzola, Giorgia
Urbino, Rosario
Mascia, Luciana
Ferrone, Giuliano
Pohjanjousi, Pasi
Ferreyra, Gabriela
Antonelli, Massimo
author_facet Conti, Giorgio
Ranieri, Vito Marco
Costa, Roberta
Garratt, Chris
Wighton, Andrew
Spinazzola, Giorgia
Urbino, Rosario
Mascia, Luciana
Ferrone, Giuliano
Pohjanjousi, Pasi
Ferreyra, Gabriela
Antonelli, Massimo
author_sort Conti, Giorgio
collection PubMed
description BACKGROUND: Dexmedetomidine 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. METHODS: We 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. RESULTS: The 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. CONCLUSIONS: When 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.
format Online
Article
Text
id pubmed-4930611
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-49306112016-07-03 Effects of dexmedetomidine and propofol on patient-ventilator interaction in difficult-to-wean, mechanically ventilated patients: a prospective, open-label, randomised, multicentre study Conti, Giorgio Ranieri, Vito Marco Costa, Roberta Garratt, Chris Wighton, Andrew Spinazzola, Giorgia Urbino, Rosario Mascia, Luciana Ferrone, Giuliano Pohjanjousi, Pasi Ferreyra, Gabriela Antonelli, Massimo Crit Care Research BACKGROUND: Dexmedetomidine 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. METHODS: We 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. RESULTS: The 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. CONCLUSIONS: When 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. BioMed Central 2016-07-02 2016 /pmc/articles/PMC4930611/ /pubmed/27368279 http://dx.doi.org/10.1186/s13054-016-1386-2 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Conti, Giorgio
Ranieri, Vito Marco
Costa, Roberta
Garratt, Chris
Wighton, Andrew
Spinazzola, Giorgia
Urbino, Rosario
Mascia, Luciana
Ferrone, Giuliano
Pohjanjousi, Pasi
Ferreyra, Gabriela
Antonelli, Massimo
Effects of dexmedetomidine and propofol on patient-ventilator interaction in difficult-to-wean, mechanically ventilated patients: a prospective, open-label, randomised, multicentre study
title Effects of dexmedetomidine and propofol on patient-ventilator interaction in difficult-to-wean, mechanically ventilated patients: a prospective, open-label, randomised, multicentre study
title_full Effects of dexmedetomidine and propofol on patient-ventilator interaction in difficult-to-wean, mechanically ventilated patients: a prospective, open-label, randomised, multicentre study
title_fullStr Effects of dexmedetomidine and propofol on patient-ventilator interaction in difficult-to-wean, mechanically ventilated patients: a prospective, open-label, randomised, multicentre study
title_full_unstemmed Effects of dexmedetomidine and propofol on patient-ventilator interaction in difficult-to-wean, mechanically ventilated patients: a prospective, open-label, randomised, multicentre study
title_short Effects of dexmedetomidine and propofol on patient-ventilator interaction in difficult-to-wean, mechanically ventilated patients: a prospective, open-label, randomised, multicentre study
title_sort effects of dexmedetomidine and propofol on patient-ventilator interaction in difficult-to-wean, mechanically ventilated patients: a prospective, open-label, randomised, multicentre study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930611/
https://www.ncbi.nlm.nih.gov/pubmed/27368279
http://dx.doi.org/10.1186/s13054-016-1386-2
work_keys_str_mv AT contigiorgio effectsofdexmedetomidineandpropofolonpatientventilatorinteractionindifficulttoweanmechanicallyventilatedpatientsaprospectiveopenlabelrandomisedmulticentrestudy
AT ranierivitomarco effectsofdexmedetomidineandpropofolonpatientventilatorinteractionindifficulttoweanmechanicallyventilatedpatientsaprospectiveopenlabelrandomisedmulticentrestudy
AT costaroberta effectsofdexmedetomidineandpropofolonpatientventilatorinteractionindifficulttoweanmechanicallyventilatedpatientsaprospectiveopenlabelrandomisedmulticentrestudy
AT garrattchris effectsofdexmedetomidineandpropofolonpatientventilatorinteractionindifficulttoweanmechanicallyventilatedpatientsaprospectiveopenlabelrandomisedmulticentrestudy
AT wightonandrew effectsofdexmedetomidineandpropofolonpatientventilatorinteractionindifficulttoweanmechanicallyventilatedpatientsaprospectiveopenlabelrandomisedmulticentrestudy
AT spinazzolagiorgia effectsofdexmedetomidineandpropofolonpatientventilatorinteractionindifficulttoweanmechanicallyventilatedpatientsaprospectiveopenlabelrandomisedmulticentrestudy
AT urbinorosario effectsofdexmedetomidineandpropofolonpatientventilatorinteractionindifficulttoweanmechanicallyventilatedpatientsaprospectiveopenlabelrandomisedmulticentrestudy
AT mascialuciana effectsofdexmedetomidineandpropofolonpatientventilatorinteractionindifficulttoweanmechanicallyventilatedpatientsaprospectiveopenlabelrandomisedmulticentrestudy
AT ferronegiuliano effectsofdexmedetomidineandpropofolonpatientventilatorinteractionindifficulttoweanmechanicallyventilatedpatientsaprospectiveopenlabelrandomisedmulticentrestudy
AT pohjanjousipasi effectsofdexmedetomidineandpropofolonpatientventilatorinteractionindifficulttoweanmechanicallyventilatedpatientsaprospectiveopenlabelrandomisedmulticentrestudy
AT ferreyragabriela effectsofdexmedetomidineandpropofolonpatientventilatorinteractionindifficulttoweanmechanicallyventilatedpatientsaprospectiveopenlabelrandomisedmulticentrestudy
AT antonellimassimo effectsofdexmedetomidineandpropofolonpatientventilatorinteractionindifficulttoweanmechanicallyventilatedpatientsaprospectiveopenlabelrandomisedmulticentrestudy