RT Journal Article
T1 Effects of sedatives and opioids on trigger and cycling asynchronies throughout mechanical ventilation: an observational study in a large dataset from critically ill patients.
A1 de Haro, Candelaria
A1 Magrans, Rudys
A1 López-Aguilar, Josefina
A1 Montanyà, Jaume
A1 Lena, Enrico
A1 Subirà, Carles
A1 Fernandez-Gonzalo, Sol
A1 Gomà, Gemma
A1 Fernández, Rafael
A1 Albaiceta, Guillermo M
A1 Skrobik, Yoanna
A1 Lucangelo, Umberto
A1 Murias, Gastón
A1 Ochagavia, Ana
A1 Kacmarek, Robert M
A1 Rue, Montserrat
A1 Blanch, Lluís
A1 Asynchronies in the Intensive Care Unit (ASYNICU) Group, 
K1 Asynchronies
K1 Double cycling
K1 Ineffective inspiratory efforts during expiration
K1 Mechanical ventilation
K1 Opioids
K1 Sedatives
AB 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. 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. 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  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. ClinicalTrial.gov, NCT03451461.
YR 2019
FD 2019-07-05
LK https://hdl.handle.net/10668/26306
UL https://hdl.handle.net/10668/26306
LA en
DS RISalud
RD Apr 6, 2025