Effects of sedatives and opioids on trigger and cycling asynchronies throughout mechanical ventilation: an observational study in a large dataset from critically ill patients
Author
De Haro, Candelaria
Magrans, Rudys
López-Aguilar, Josefina
Montanyà, Jaume
Lena, Enrico
Subirà Cuyàs, Carles
Fernandez-Gonzalo, Sol
Gomà Fernández, Gemma
Fernández Fernández, Rafael
Albaiceta, Guillermo M.
Skrobik, Yoanna
Lucangelo, Umberto
Murias, Gastón
Ochagavia, Ana
Kacmarek, Robert M.
Rué, Montserrat
Blanch, Lluís
Asynchronies in the Intensive Care Unit (ASYNICU) Group
Publication date
2019-07-05ISSN
1364-8535
Abstract
Background: 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.
Document Type
Article
Document version
Accepted version
Language
English
Subject (CDU)
61 - Medicina
Keywords
Medicaments
Respiració artificial
Opiacis
Pacients hospitalitzats
Medicamentos
Respiración artificial
Opiáceos
Pacientes hospitalizados
Medications
Mechanical ventilation
Opioids
Hospitalized patients
Pages
11
Publisher
Springer Nature
Collection
23;245
Is part of
Critical Care
Citation
De 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.
This item appears in the following Collection(s)
- Ciències de la Salut [532]
Rights
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.
Except where otherwise noted, this item's license is described as http://creativecommons.org/licenses/by/4.0/