西培泊酚对机械通气患者呼吸模式、呼吸驱动和吸气努力的影响。
Effects of cipepofol on breathing patterns, respiratory drive, and inspiratory effort in mechanically ventilated patients.
作者信息
Su Rui, Zhang Linlin, Wang Yu-Mei, Miao Ming-Yue, Wang Shuya, Cao Yong, Zhou Jian-Xin
机构信息
Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
出版信息
Front Med (Lausanne). 2025 Feb 25;12:1539238. doi: 10.3389/fmed.2025.1539238. eCollection 2025.
BACKGROUND
Cipepofol is a highly selective gamma-aminobutyric acid A receptor potentiator. As a new sedative drug, detailed studies on its respiratory effects are further needed. The present study aims to investigate the effects of cipepofol on breathing patterns, respiratory drive, and inspiratory effort in mechanically ventilated patients.
METHODS
In this one-arm physiological study, cipepofol was initiated at 0.3 mg/kg/h and increased by 0.1 mg/kg/h every 30 min until reaching 0.8 mg/kg/h. Discontinuation criteria were Richmond Agitation and Sedation Scale (RASS) score ≤ -4 or respiratory rate (RR) < 8 breaths/min or pulse oxygen saturation (SpO) < 90%. The primary outcomes were changes from baseline in respiratory variables [RR, tidal volume (VT), minute ventilation (V), airway occlusion pressure at 100 msec (P), pressure muscle index (PMI), expiratory occlusion pressure (P)] at 30 min after 0.3 mg/kg/h cipepofol infusion. The secondary outcomes included changes in respiratory variables, cardiorespiratory variables, and RASS scores at rates of cipepofol from 0.3 to 0.8 mg/kg/h.
RESULTS
20 patients were enrolled and all of them completed the cipepofol infusion rate at 0.3 mg/kg/h, achieving RASS score of -2 to +1. For the primary outcomes, there was a significant reduction in VT (390.9, [356.6-511.0] vs. 451.6 [393.5-565.9], = 0.002), while changes in RR (16.7 ± 2.7 vs. 16.2 ± 3.4, = 0.465) and V (7.2 ± 1.8 vs. 7.5 ± 1.9, = 0.154) were not significant. The reductions in P ( = 0.020), PMI ( = 0.019), and P ( = 0.007) were significant. For secondary outcomes, as the infusion rate of cipepofol increased from 0.3 to 0.8 mg/kg/h, there was a further decrease in VT ( = 0.002) and an increase in RR ( < 0.001), while the change in V ( = 0.430) was not significant. RASS score ( < 0.001) was further decreased.
CONCLUSION
Cipepofol demonstrates the capability to achieve RASS score -2 to +1 in mechanically ventilated adult patients. The effect of cipepofol on breathing patterns was a decrease in VT, while changes in RR and V were insignificant. The effect on respiratory drive and inspiratory effort significantly reduced P, PMI, and P.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, identifier NCT06287138. https://clinicaltrials.gov/study/NCT06287138.
背景
西派泊酚是一种高选择性γ-氨基丁酸A受体增强剂。作为一种新型镇静药物，仍需对其呼吸效应进行深入研究。本研究旨在探讨西派泊酚对机械通气患者呼吸模式、呼吸驱动力和吸气努力的影响。
方法
在这项单臂生理学研究中，西派泊酚起始剂量为0.3mg/kg/h，每30分钟增加0.1mg/kg/h，直至达到0.8mg/kg/h。停药标准为里士满躁动镇静量表（RASS）评分≤ -4或呼吸频率（RR）<8次/分钟或脉搏血氧饱和度（SpO）<90%。主要结局指标为在输注0.3mg/kg/h西派泊酚30分钟后，呼吸变量[RR、潮气量（VT）、分钟通气量（V）、100毫秒时的气道闭塞压（P）、压力肌肉指数（PMI）、呼气闭塞压（P）]相对于基线的变化。次要结局指标包括西派泊酚剂量从0.3mg/kg/h增加至0.8mg/kg/h时，呼吸变量、心肺变量和RASS评分的变化。
结果
纳入20例患者，所有患者均完成了0.3mg/kg/h的西派泊酚输注，RASS评分为-2至+1。对于主要结局指标，VT显著降低（390.9，[356.6 - 511.0] vs. 451.6 [393.5 - 565.9]，P = 0.002），而RR（16.7 ± 2.7 vs. 16.2 ± 3.4，P = 0.465）和V（7.2 ± 1.8 vs. 7.5 ± 1.9，P = 0.154）的变化不显著。P（P = 0.020）、PMI（P = 0.019）和P（P = 0.007）的降低显著。对于次要结局指标，随着西派泊酚输注速率从0.3mg/kg/h增加至0.8mg/kg/h，VT进一步降低（P = 0.002），RR增加（P < 0.001），而V的变化不显著（P = 0.430）。RASS评分进一步降低（P < 0.001）。
结论
西派泊酚能使机械通气成年患者的RASS评分达到-2至+1。西派泊酚对呼吸模式的影响是使VT降低，而RR和V的变化不显著。对呼吸驱动力和吸气努力的影响显著降低了P、PMI和P。
临床试验注册
ClinicalTrials.gov，标识符NCT06287138。https://clinicaltrials.gov/study/NCT06287138。
Zotero 插件