Effects of dexmedetomidine and propofol on patient-ventilator interaction in difficult-to-wean, mechanically ventilated patients: A prospective, open-label, randomised, multicentre study

Giorgio Conti, Massimo Antonelli, Roberta Costa, Giorgia Spinazzola, Giuliano Ferrone, Vito Marco Ranieri, Chris Garratt, Andrew Wighton, Rosario Urbino, Luciana Mascia, Pasi Pohjanjousi, Gabriela Ferreyra

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Abstract

Background: Dexmedetomidine can be used for sedation of mechanically ventilated patients and has minor respiratory effects. The aim of this study was to compare the incidence of patient-ventilator dyssynchronies during sedation with dexmedetomidine or propofol. Methods: We conducted a multicentre, prospective, open-label, randomised clinical trial, comparing dexmedetomidine with standard propofol sedation at three intensive care units of university hospitals in Italy. Twenty difficult-to-wean patients for whom the first weaning trial had failed and who were on pressure support ventilation were randomised to receive sedation with either dexmedetomidine or propofol at a similar level of sedation (Richmond Agitation-Sedation Scale [RASS] score +1 to -2). The asynchrony index (AI) was calculated using tracings of airflow, airway pressure and electrical activity of the diaphragm sampled at 0, 0.5, 1, 2, 6, 12, 18 and 24 h. Results: The mean AI was lower with dexmedetomidine than with propofol from 2 h onwards, although the two groups significantly differed only at 12 h (2.68 % vs 9.10 %, p < 0.05). No further difference was observed at 18 and 24 h. Conclusions: When sedation with propofol and dexmedetomidine was compared at similar RASS scores of patients in whom first weaning trial had failed, the AI was lower with dexmedetomidine than with propofol, and this difference was statistically significant at 12 h. These results suggest that sedation with dexmedetomidine may offer some advantages in terms of patient-ventilator synchrony.
Original languageEnglish
Pages (from-to)1386-1392
Number of pages7
JournalCritical Care
Volume20
DOIs
Publication statusPublished - 2016

Keywords

  • Critical Care and Intensive Care Medicine
  • Dexmedetomidine
  • Mechanical ventilation
  • Patient-ventilator synchrony
  • Propofol
  • Sedation

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