Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, Saarland University Faculty of Medicine, Homburg, Germany.
Outcomes Research Consortium, Cleveland, Ohio, USA.
Acta Anaesthesiol Scand. 2022 Mar;66(3):354-364. doi: 10.1111/aas.14010. Epub 2021 Dec 14.
Spontaneous breathing is desirable in most ventilated patients. We therefore studied the influence of isoflurane versus propofol sedation on early spontaneous breathing in ventilated surgical intensive care patients and evaluated potential mediation by opioids and arterial carbon dioxide during the first 20 h of study sedation.
We included a single-center subgroup of 66 patients, who participated in a large multi-center trial assessing efficacy and safety of isoflurane sedation, with 33 patients each randomized to isoflurane or propofol sedation. Both sedatives were titrated to a sedation depth of -4 to -1 on the Richmond Agitation Sedation Scale. The primary outcome was the fraction of time during which patients breathed spontaneously.
Baseline characteristics of isoflurane and propofol-sedated patients were well balanced. There were no substantive differences in management or treatment aside from sedation, and isoflurane and propofol provided nearly identical sedation depths. The mean fraction of time spent spontaneously breathing was 82% [95% CI: 69, 90] in patients sedated with isoflurane compared to 35% [95% CI: 22, 51] in those assigned to propofol: median difference: 61% [95% CI: 14, 89], p < .001. After adjustments for sufentanil dose and arterial carbon dioxide partial pressure, patients sedated with isoflurane were twice as likely to breathe spontaneously than those sedated with propofol: adjusted risk ratio: 2.2 [95%CI: 1.4, 3.3], p < .001.
Isoflurane compared to propofol sedation promotes early spontaneous breathing in deeply sedated ventilated intensive care patients. The benefit appears to be a direct effect isoflurane rather than being mediated by opioids or arterial carbon dioxide.
在大多数接受通气治疗的患者中，自主呼吸是理想的。因此，我们研究了异氟醚与丙泊酚镇静对通气重症监护患者早期自主呼吸的影响，并在研究镇静的前 20 小时内评估了阿片类药物和动脉二氧化碳潜在的介导作用。
我们纳入了一项大型多中心试验的单中心亚组，该试验评估了异氟醚镇静的疗效和安全性，其中 33 例患者随机分为异氟醚或丙泊酚镇静组。两种镇静剂均滴定至 Richmond 躁动-镇静量表的-4 至-1 镇静深度。主要结局是患者自主呼吸的时间比例。
异氟醚和丙泊酚镇静患者的基线特征平衡良好。除镇静外，管理或治疗没有实质性差异，异氟醚和丙泊酚提供了几乎相同的镇静深度。异氟醚镇静组患者自主呼吸的时间比例为 82%[95%CI：69，90]，而丙泊酚镇静组为 35%[95%CI：22，51]：中位数差异：61%[95%CI：14，89]，p<0.001。调整舒芬太尼剂量和动脉二氧化碳分压后，异氟醚镇静患者自主呼吸的可能性是丙泊酚镇静患者的两倍：调整风险比：2.2[95%CI：1.4，3.3]，p<0.001。
与丙泊酚镇静相比，异氟醚镇静可促进深度镇静通气重症监护患者的早期自主呼吸。这种益处似乎是异氟醚的直接作用，而不是通过阿片类药物或动脉二氧化碳介导的。
