de Haro, CandelariaMagrans, RudysLópez-Aguilar, JosefinaMontanyà, JaumeLena, EnricoSubirà, CarlesFernandez-Gonzalo, SolGomà, GemmaFernández, RafaelAlbaiceta, Guillermo MSkrobik, YoannaLucangelo, UmbertoMurias, GastónOchagavia, AnaKacmarek, Robert MRue, MontserratBlanch, LluísAsynchronies in the Intensive Care Unit (ASYNICU) Group2025-01-072025-01-072019-07-05https://hdl.handle.net/10668/26306In 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.enAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/AsynchroniesDouble cyclingIneffective inspiratory efforts during expirationMechanical ventilationOpioidsSedativesAgedAnalgesics, OpioidCritical IllnessFemaleHumansHypnotics and SedativesIntensive Care UnitsMaleMiddle AgedProspective StudiesRespiration, ArtificialRespiratory MechanicsSpainresearch article31277722open access10.1186/s13054-019-2531-51466-609XPMC6612107https://ccforum.biomedcentral.com/track/pdf/10.1186/s13054-019-2531-5https://pmc.ncbi.nlm.nih.gov/articles/PMC6612107/pdf