Ghazaly Huda F, Elansary Mohamed M, Mahmoud Ahmed A, Hasanen Mohamed K, Hassan Mahmoud M
Anesthesia and Intensive Care, Faculty of Medicine, Aswan University, Aswan, Egypt.
J Anaesthesiol Clin Pharmacol. 2024 Oct-Dec;40(4):619-625. doi: 10.4103/joacp.joacp_145_23. Epub 2024 Apr 26.
Even though patient tolerance is critical to the success of noninvasive ventilation (NIV), research on using sedation to improve tolerance to NIV after traumatic chest injuries is limited. We hypothesized that dexmedetomidine would be superior to ketamine in terms of patient tolerance and lengthening the NIV sessions after blunt chest trauma.
This randomized, double-blinded, placebo-controlled trial included 45 patients of both genders aged 18-60 who needed NIV after blunt chest trauma. The patients were randomly assigned to one of three groups ( = 15) for receiving dexmedetomidine, ketamine, or placebo (0.9% sodium chloride solution) infusion to maintain a Richmond Agitation Sedation Scale (RASS) score between 0 and - 3 during two successive NIV sessions. Patients were evaluated for the duration of the NIV sessions, RASS, Visual Analog Scale (VAS), and the total amount of rescue analgesia consumed.
The mean duration of the NIV sessions was significantly longer in patients who received dexmedetomidine ( < 0.001) or ketamine ( < 0.001) compared to placebo. However, the NIV durations did not differ significantly between the dexmedetomidine and ketamine groups ( > 0.05). The dexmedetomidine group had a significantly lower RASS score compared to the ketamine ( < 0.001) and placebo ( < 0.001) groups, whereas the ketamine group had a significantly lower VAS compared to the dexmedetomidine ( = 0.005) and placebo ( = 0.022) groups and required significantly less total morphine ( = 0.001) compared to the other groups.
The duration of the NIV sessions for patients with blunt chest trauma did not differ significantly between the dexmedetomidine and ketamine groups.
尽管患者耐受性对无创通气（NIV）的成功至关重要，但关于使用镇静剂提高创伤性胸部损伤后对NIV耐受性的研究有限。我们假设在钝性胸部创伤后，右美托咪定在患者耐受性和延长NIV疗程方面优于氯胺酮。
这项随机、双盲、安慰剂对照试验纳入了45名年龄在18至60岁之间、钝性胸部创伤后需要NIV的男女患者。患者被随机分配到三组之一（每组n = 15），接受右美托咪定、氯胺酮或安慰剂（0.9%氯化钠溶液）输注，以在连续两次NIV疗程期间将里士满躁动镇静量表（RASS）评分维持在0至 -3之间。评估患者的NIV疗程持续时间、RASS评分、视觉模拟量表（VAS）评分以及使用的急救镇痛总量。
与安慰剂相比，接受右美托咪定（P < 0.001）或氯胺酮（P < 0.001）的患者NIV疗程的平均持续时间显著更长。然而，右美托咪定组和氯胺酮组之间的NIV持续时间差异不显著（P > 0.05）。与氯胺酮组（P < 0.001）和安慰剂组（P < 0.001）相比，右美托咪定组的RASS评分显著更低，而与右美托咪定组（P = 0.005）和安慰剂组（P = 0.022）相比，氯胺酮组的VAS评分显著更低，并且与其他组相比，氯胺酮组所需的吗啡总量显著更少（P = 0.001）。
钝性胸部创伤患者的NIV疗程持续时间在右美托咪定组和氯胺酮组之间差异不显著。
