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dc.contributor.authorDe Haro, Candelaria
dc.contributor.authorMagrans, Rudys
dc.contributor.authorLópez-Aguilar, Josefina
dc.contributor.authorMontanyà, Jaume
dc.contributor.authorLena, Enrico
dc.contributor.authorSubirà Cuyàs, Carles
dc.contributor.authorFernandez-Gonzalo, Sol
dc.contributor.authorGomà Fernández, Gemma
dc.contributor.authorFernández Fernández, Rafael
dc.contributor.authorAlbaiceta, Guillermo M.
dc.contributor.authorSkrobik, Yoanna
dc.contributor.authorLucangelo, Umberto
dc.contributor.authorMurias, Gastón
dc.contributor.authorOchagavia, Ana
dc.contributor.authorKacmarek, Robert M.
dc.contributor.authorRué, Montserrat
dc.contributor.authorBlanch, Lluís
dc.contributor.authorAsynchronies in the Intensive Care Unit (ASYNICU) Group
dc.date.accessioned2020-04-21T16:32:13Z
dc.date.available2020-04-21T16:32:13Z
dc.date.issued2019-07-05
dc.identifier.citationDe Haro, Candelaria; Magrans, Rudys; López-Aguilar, Josefina [et al.]. Effects of sedatives and opioids on trigger and cycling asynchronies throughout mechanical ventilation: an observational study in a large dataset from critically ill patients. Critical Care, 2019, 23(245), p. 1-11. Disponible en: <https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2531-5>. Fecha de acceso: 21 abr. de 2020. DOI: 10.1186/s13054-019-2531-5.ca
dc.identifier.issn1364-8535ca
dc.identifier.urihttp://hdl.handle.net/20.500.12328/1482
dc.description.abstractBackground: In critically ill patients, poor patient-ventilator interaction may worsen outcomes. Although sedatives are often administered to improve comfort and facilitate ventilation, they can be deleterious. Whether opioids improve asynchronies with fewer negative effects is unknown. We hypothesized that opioids alone would improve asynchronies and result in more wakeful patients than sedatives alone or sedatives-plus-opioids. Methods: This prospective multicenter observational trial enrolled critically ill adults mechanically ventilated (MV) > 24 h. We compared asynchronies and sedation depth in patients receiving sedatives, opioids, or both. We recorded sedation level and doses of sedatives and opioids. BetterCare™ software continuously registered ineffective inspiratory efforts during expiration (IEE), double cycling (DC), and asynchrony index (AI) as well as MV modes. All variables were averaged per day. We used linear mixed-effects models to analyze the relationships between asynchronies, sedation level, and sedative and opioid doses. Results: In 79 patients, 14,166,469 breaths were recorded during 579 days of MV. Overall asynchronies were not significantly different in days classified as sedatives-only, opioids-only, and sedatives-plus-opioids and were more prevalent in days classified as no-drugs than in those classified as sedatives-plus-opioids, irrespective of the ventilatory mode. Sedative doses were associated with sedation level and with reduced DC (p < 0.0001) in sedatives-only days. However, on days classified as sedatives-plus-opioids, higher sedative doses and deeper sedation had more IEE (p < 0.0001) and higher AI (p = 0.0004). Opioid dosing was inversely associated with overall asynchronies (p < 0.001) without worsening sedation levels into morbid ranges. Conclusions: Sedatives, whether alone or combined with opioids, do not result in better patient-ventilator interaction than opioids alone, in any ventilatory mode. Higher opioid dose (alone or with sedatives) was associated with lower AI without depressing consciousness. Higher sedative doses administered alone were associated only with less DC.ca
dc.format.extent11ca
dc.language.isoengca
dc.publisherSpringer Natureca
dc.relation.ispartofCritical Careca
dc.relation.ispartofseries23;245
dc.rightsThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.ca
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subject.otherMedicamentsca
dc.subject.otherRespiració artificial
dc.subject.otherOpiacis
dc.subject.otherPacients hospitalitzats
dc.subject.otherMedicamentos
dc.subject.otherRespiración artificial
dc.subject.otherOpiáceos
dc.subject.otherPacientes hospitalizados
dc.subject.otherMedications
dc.subject.otherMechanical ventilation
dc.subject.otherOpioids
dc.subject.otherHospitalized patients
dc.titleEffects of sedatives and opioids on trigger and cycling asynchronies throughout mechanical ventilation: an observational study in a large dataset from critically ill patientsca
dc.typeinfo:eu-repo/semantics/articleca
dc.description.versioninfo:eu-repo/semantics/acceptedVersionca
dc.embargo.termscapca
dc.subject.udc61ca
dc.identifier.doihttps://dx.doi.org/10.1186/s13054-019-2531-5ca


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This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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