Service de réanimation médicale, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, Université Denis Diderot, 178 rue des Renouillers 92701 Colombes Cedex, France.
Crit Care. 2010;14(3):R86. doi: 10.1186/cc9015. Epub 2010 May 12.
Interruption of sedation during weaning from mechanical ventilation often leads to patient agitation because of withdrawal syndrome. We tested the short-term efficacy and tolerance of loxapine in this situation.
Nineteen mechanically ventilated patients with marked agitation after sedation withdrawal were included. Three agitation scales, the Richmond Agitation Sedation Scale (RASS), the Motor Activity Assessment Scale (MAAS), and the Ramsay and physiological variables (respiratory rate, airway occlusion pressure during the first 0.1 second of inspiration (P0.1), heart rate and systolic arterial blood pressure) were recorded before and after loxapine administration.
Loxapine dramatically improved all agitation scores (RASS and MASS decreased from 2 +/- 0 to -1.1 +/- 2.3, and 5.4 +/- 0.5 to 2.7 +/- 1.6, respectively; Ramsay increased from 1.0 +/- 0 to 3.5 +/- 1.5, 60 minutes after loxapine administration, P < 0.05 for all scores) as well as P0.1 (6 +/- 4.2 to 1.8 +/- 1.8 cm H2O; P < 0.05) and respiratory rate (from 31.2 +/- 7.2 to 23.4 +/- 7.8; P < 0.05) without hemodynamic adverse events. No side effects occurred. Sixteen (84%) patients were successfully managed with loxapine, sedation was resumed in two others, and one patient self-extubated without having to be reintubated.
Loxapine was safe and effective in treating agitation in a small group of mechanically ventilated patients and improved respiratory physiologic parameters, enabling the weaning process to be pursued. A multicenter trial is under way to confirm these promising results.
在机械通气撤机过程中镇静的中断常导致戒断综合征，使患者出现激越。我们检测了氯氮平在这种情况下的短期疗效和耐受性。
19 例镇静撤机后明显激越的机械通气患者被纳入研究。在氯氮平给药前后分别记录 3 种激越评分（Richmond 躁动镇静评分（RASS）、运动活动评估量表（MAAS）、Ramsay 镇静评分）和生理变量（呼吸频率、吸气开始后 0.1 秒的气道阻断压（P0.1）、心率和收缩压）。
氯氮平显著改善了所有激越评分（RASS 和 MAAS 评分分别从 2 ± 0 降至-1.1 ± 2.3 和 5.4 ± 0.5 降至 2.7 ± 1.6；Ramsay 评分从 1.0 ± 0 增至 3.5 ± 1.5，给药后 60 分钟，所有评分 P < 0.05），以及 P0.1（从 6 ± 4.2 降至 1.8 ± 1.8 cm H2O；P < 0.05）和呼吸频率（从 31.2 ± 7.2 降至 23.4 ± 7.8；P < 0.05），而无血流动力学不良事件。未发生不良反应。16 例（84%）患者用氯氮平成功治疗，另外 2 例恢复镇静，1 例患者自行脱机，无需重新插管。
氯氮平治疗机械通气患者激越安全有效，改善了呼吸生理参数，使撤机过程得以继续。一项多中心试验正在进行中，以确认这些有前景的结果。
