Müller-Wirtz Lukas M, Becher Tobias, Günther Ulf, Bellgardt Martin, Sackey Peter, Volk Thomas, Meiser Andreas
Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, 66421 Homburg, Germany.
Outcomes Research Consortium, Cleveland, OH 44195, USA.
J Clin Med. 2023 May 6;12(9):3314. doi: 10.3390/jcm12093314.
Devices used to deliver inhaled sedation increase dead space ventilation. We therefore compared ventilatory effects among isoflurane sedation via the Sedaconda ACD-S (internal volume: 50 mL), isoflurane sedation via the Sedaconda ACD-L (100 mL), and propofol sedation with standard mechanical ventilation with heat and moisture exchangers (HME). This is a substudy of a randomized trial that compared inhaled isoflurane sedation via the ACD-S or ACD-L to intravenous propofol sedation in 301 intensive care patients. Data from the first 24 h after study inclusion were analyzed using linear mixed models. Primary outcome was minute ventilation. Secondary outcomes were tidal volume, respiratory rate, arterial carbon dioxide pressure, and isoflurane consumption. In total, 151 patients were randomized to propofol and 150 to isoflurane sedation; 64 patients received isoflurane via the ACD-S and 86 patients via the ACD-L. While use of the ACD-L was associated with higher minute ventilation (average difference (95% confidence interval): 1.3 (0.7, 1.8) L/min, < 0.001), higher tidal volumes (44 (16, 72) mL, = 0.002), higher respiratory rates (1.2 (0.1, 2.2) breaths/min, = 0.025), and higher arterial carbon dioxide pressures (3.4 (1.2, 5.6) mmHg, = 0.002), use of the ACD-S did not significantly affect ventilation compared to standard mechanical ventilation and sedation. Isoflurane consumption was slightly less with the ACD-L compared to the ACD-S (-0.7 (-1.3, 0.1) mL/h, = 0.022). The Sedaconda ACD-S compared to the ACD-L is associated with reduced minute ventilation and does not significantly affect ventilation compared to a standard mechanical ventilation and sedation setting. The smaller ACD-S is therefore the device of choice to minimize impact on ventilation, especially in patients with a limited ability to compensate (e.g., COPD patients). Volatile anesthetic consumption is slightly higher with the ACD-S compared to the ACD-L.
用于实施吸入镇静的设备会增加无效腔通气。因此，我们比较了通过Sedaconda ACD - S（内部容积：50 mL）进行异氟烷镇静、通过Sedaconda ACD - L（100 mL）进行异氟烷镇静以及使用带热湿交换器（HME）的标准机械通气进行丙泊酚镇静的通气效果。这是一项随机试验的子研究，该试验比较了301例重症监护患者中通过ACD - S或ACD - L进行吸入异氟烷镇静与静脉注射丙泊酚镇静的效果。使用线性混合模型分析了纳入研究后最初24小时的数据。主要结局是分钟通气量。次要结局是潮气量、呼吸频率、动脉二氧化碳分压和异氟烷消耗量。总共151例患者被随机分配至丙泊酚组，150例患者被随机分配至异氟烷镇静组；64例患者通过ACD - S接受异氟烷，86例患者通过ACD - L接受异氟烷。虽然使用ACD - L与更高的分钟通气量相关（平均差值（95%置信区间）：1.3（0.7，1.8）L/分钟，<0.001）、更高的潮气量（44（16，72）mL，=0.002）、更高的呼吸频率（1.2（0.1，2.2）次/分钟，=0.025）以及更高的动脉二氧化碳分压（3.4（1.2，5.6）mmHg，=0.002），但与标准机械通气和镇静相比，使用ACD - S对通气没有显著影响。与ACD - S相比，ACD - L的异氟烷消耗量略少（-0.7（-1.3，0.1）mL/小时，=0.022）。与ACD - L相比，Sedaconda ACD - S与更低的分钟通气量相关，并且与标准机械通气和镇静设置相比，对通气没有显著影响。因此，较小的ACD - S是将对通气的影响降至最低的首选设备，尤其是对于代偿能力有限的患者（例如慢性阻塞性肺疾病患者）。与ACD - L相比，ACD - S的挥发性麻醉剂消耗量略高。
