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Loxapine to control agitation during weaning from mechanical ventilation

BACKGROUND: Weaning from mechanical ventilation (MV) may be impeded by the occurrence of agitation. Loxapine has the ability to control agitation without affecting spontaneous ventilation. The aim of this study was to establish whether loxapine would reduce MV weaning duration in agitated patients....

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Autores principales: Gaudry, Stéphane, Sztrymf, Benjamin, Sonneville, Romain, Megarbane, Bruno, Van Der Meersch, Guillaume, Vodovar, Dominique, Cohen, Yves, Ricard, Jean-Damien, Hajage, David, Salomon, Laurence, Dreyfuss, Didier
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586048/
https://www.ncbi.nlm.nih.gov/pubmed/28877705
http://dx.doi.org/10.1186/s13054-017-1822-y
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author Gaudry, Stéphane
Sztrymf, Benjamin
Sonneville, Romain
Megarbane, Bruno
Van Der Meersch, Guillaume
Vodovar, Dominique
Cohen, Yves
Ricard, Jean-Damien
Hajage, David
Salomon, Laurence
Dreyfuss, Didier
author_facet Gaudry, Stéphane
Sztrymf, Benjamin
Sonneville, Romain
Megarbane, Bruno
Van Der Meersch, Guillaume
Vodovar, Dominique
Cohen, Yves
Ricard, Jean-Damien
Hajage, David
Salomon, Laurence
Dreyfuss, Didier
author_sort Gaudry, Stéphane
collection PubMed
description BACKGROUND: Weaning from mechanical ventilation (MV) may be impeded by the occurrence of agitation. Loxapine has the ability to control agitation without affecting spontaneous ventilation. The aim of this study was to establish whether loxapine would reduce MV weaning duration in agitated patients. METHODS: We performed a multicentre, double-blind, placebo-controlled, parallel group, randomised trial. Patients who were potential candidates for weaning but exhibited agitation (Richmond Agitation-Sedation Scale score ≥ 2) after sedation withdrawal were randomly assigned to receive either loxapine or placebo. In case of severe agitation, conventional sedation was immediately resumed. The primary endpoint was the time between first administration of loxapine or placebo and successful extubation. RESULTS: The trial was discontinued after 102 patients were enrolled because of an insufficient inclusion rate. Median times to successful extubation were 3.2 days in the loxapine group and 5 days in the placebo group (relative risk 1.2, 95% CI 0.75–1.88, p = 0.45). During the first 24 h, sedation was more frequently resumed in the placebo group (44% vs 17%, p = 0.01). CONCLUSIONS: In this prematurely stopped trial, loxapine did not significantly shorten weaning from MV. However, loxapine reduced the need for resuming sedation. TRIAL REGISTRATION: Clinicaltrials.gov, NCT01193816. Registered on 26 August 2010.
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spelling pubmed-55860482017-09-06 Loxapine to control agitation during weaning from mechanical ventilation Gaudry, Stéphane Sztrymf, Benjamin Sonneville, Romain Megarbane, Bruno Van Der Meersch, Guillaume Vodovar, Dominique Cohen, Yves Ricard, Jean-Damien Hajage, David Salomon, Laurence Dreyfuss, Didier Crit Care Research BACKGROUND: Weaning from mechanical ventilation (MV) may be impeded by the occurrence of agitation. Loxapine has the ability to control agitation without affecting spontaneous ventilation. The aim of this study was to establish whether loxapine would reduce MV weaning duration in agitated patients. METHODS: We performed a multicentre, double-blind, placebo-controlled, parallel group, randomised trial. Patients who were potential candidates for weaning but exhibited agitation (Richmond Agitation-Sedation Scale score ≥ 2) after sedation withdrawal were randomly assigned to receive either loxapine or placebo. In case of severe agitation, conventional sedation was immediately resumed. The primary endpoint was the time between first administration of loxapine or placebo and successful extubation. RESULTS: The trial was discontinued after 102 patients were enrolled because of an insufficient inclusion rate. Median times to successful extubation were 3.2 days in the loxapine group and 5 days in the placebo group (relative risk 1.2, 95% CI 0.75–1.88, p = 0.45). During the first 24 h, sedation was more frequently resumed in the placebo group (44% vs 17%, p = 0.01). CONCLUSIONS: In this prematurely stopped trial, loxapine did not significantly shorten weaning from MV. However, loxapine reduced the need for resuming sedation. TRIAL REGISTRATION: Clinicaltrials.gov, NCT01193816. Registered on 26 August 2010. BioMed Central 2017-09-06 /pmc/articles/PMC5586048/ /pubmed/28877705 http://dx.doi.org/10.1186/s13054-017-1822-y Text en © The Author(s). 2017 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
Gaudry, Stéphane
Sztrymf, Benjamin
Sonneville, Romain
Megarbane, Bruno
Van Der Meersch, Guillaume
Vodovar, Dominique
Cohen, Yves
Ricard, Jean-Damien
Hajage, David
Salomon, Laurence
Dreyfuss, Didier
Loxapine to control agitation during weaning from mechanical ventilation
title Loxapine to control agitation during weaning from mechanical ventilation
title_full Loxapine to control agitation during weaning from mechanical ventilation
title_fullStr Loxapine to control agitation during weaning from mechanical ventilation
title_full_unstemmed Loxapine to control agitation during weaning from mechanical ventilation
title_short Loxapine to control agitation during weaning from mechanical ventilation
title_sort loxapine to control agitation during weaning from mechanical ventilation
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586048/
https://www.ncbi.nlm.nih.gov/pubmed/28877705
http://dx.doi.org/10.1186/s13054-017-1822-y
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