Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Baden-Württemberg, Germany.
Anaesthesiol Intensive Ther. 2022;54(1):23-29. doi: 10.5114/ait.2022.113950.
Effective analgosedation for control of dyspnoea and for toleration of prone positioning (PP) in severe coronavirus disease 2019 (COVID-19) associated acute respiratory distress syndrome (ARDS) is difficult to adjust. This study was designed to evaluate the feasibility and safety of sedation with inhaled sevoflurane in combination with intravenous esketamine during PP in patients with COVID-19-ARDS (CARDS).
All mechanically ventilated COVID-19 patients admitted to the departmental intensive care unit from March to June 2020 were included in this epidemiological cohort study. Patients were sedated with inhaled sevoflurane in combination with eske-tamine during PP and not or only lightly sedated during the supine position. Assisted spontaneous breathing was applied in both prone and supine position.
Adverse events were documented prospectively, and routine ventilation parameters, hemodynamic parameters, Richmond Agitation and Sedation Scale (RASS) and sevoflurane consumption were monitored. Altogether, 146 episodes of PP in 15 patients were observed. No severe sedation-related event was observed during 2610 hours of PP. In 2498 hours (96%) patients were successfully converted to a pressure-supported spontaneous breathing mode.
Inhaled sedation with the AnaConDa-S-System (Sedana Medical AB, Danderyd, Sweden) alone is insufficient as soon as minute volume exceeds 7-8 L min-1, most likely due to technical reasons. Inhaled sedation with sevoflurane in combination with esketamine, however, safely enables prolonged prone positioning in patients with CARDS. Moreover, sedation depth was light enough to enable assisted spontaneous breathing during prone positioning.
有效镇痛以控制呼吸困难并耐受俯卧位（PP）在严重的 2019 冠状病毒病（COVID-19）相关急性呼吸窘迫综合征（ARDS）中是困难的。本研究旨在评估在 COVID-19-ARDS（CARDS）患者中使用吸入七氟醚联合静脉注射右美托咪定进行镇静的俯卧位时的可行性和安全性。
本研究为一项回顾性队列研究，纳入了 2020 年 3 月至 6 月期间入住我院重症监护病房的所有接受机械通气的 COVID-19 患者。患者在俯卧位时使用吸入七氟醚联合右美托咪定镇静，在仰卧位时不镇静或仅轻度镇静。在俯卧位和仰卧位时均采用辅助自主呼吸。
前瞻性记录不良事件，并监测常规通气参数、血流动力学参数、Richmond 躁动镇静量表（RASS）和七氟醚消耗。共观察到 15 例患者的 146 次俯卧位。在 2610 小时的俯卧位期间未观察到严重镇静相关事件。在 2498 小时（96%）的时间内，患者成功转换为压力支持自主呼吸模式。
单独使用 AnaConDa-S-系统（Sedana Medical AB，Danderyd，瑞典）进行吸入镇静，一旦分钟通气量超过 7-8 L min-1，就不足以维持镇静，最可能的原因是技术原因。然而，七氟醚联合右美托咪定的吸入镇静可安全地使 CARDS 患者长时间俯卧位。此外，镇静深度足以在俯卧位时进行辅助自主呼吸。
