Effect of Deep Sedation on Mechanical Power in Moderate to Severe Acute Respiratory Distress Syndrome: A Prospective Self-Control Study

Yongpeng Xie, Lijuan Cao, Ying Qian, Hui Zheng, Kexi Liu, Xiaomin Li, Yongpeng Xie, Lijuan Cao, Ying Qian, Hui Zheng, Kexi Liu, Xiaomin Li

Abstract

Mechanical power (MP) is a parameter for assessing ventilator-induced lung injury (VILI) in patients with acute respiratory distress syndrome (ARDS). Deep sedation inhibits the respiratory center and reduces the excessive spontaneous breathing in ARDS patients, thereby reducing transpulmonary pressure (Ptp) and lung injury. However, the effect of sedation on MP in ARDS patients is not yet clear. Therefore, the purpose of this study was to investigate the effect of deep sedation on MP in ARDS patients. Patients with moderate to severe ARDS who required mechanical ventilation were considered. Different degrees of sedation were performed on patients in three stages after 24 hours of mechanical ventilation. The three stages are as follows: stage 1 (H+3): 0 to 3 hours of sedation; patients' Ramsay score was 2-3 to obtain mild sedation; stage 2 (H+6): 4 to 6 hours of sedation; the sedation depth was adjusted to 5-6 points; and stage 3 (H+9): 7 to 9 hours of sedation; the sedation depth was adjusted to 2-3 points. Under deep sedation (H+6), MP, respiratory rate (RR), and Ptp were significantly lower than the ones in the patients under mild sedation (H+3) (all P < 0.01) although PaO2 /FiO2 (P/F) and static lung compliance (Cst) were significantly higher (both P < 0.01). However, no significant difference in the above parameters was observed between H+3 and H+9. Correlation analysis showed that ΔMP was significantly and positively correlated with ΔRR and ΔPtp (both P < 0.001), while no correlation was observed neither between ΔMP and ΔCst nor between ΔMP and ΔP/F. The 28-day Kaplan-Meier survival curve showed the occurrence of 19 deaths, and the overall survival rate was 63.46%. The survival rate was 53.12% in the high-MP (HMP) group and 80.95 in the low-MP (LMP) group (P < 0.05). In conclusion, deep sedation significantly reduced MP in patients with moderate to severe ARDS, thereby reducing the occurrence of VILI. In addition, MP monitoring in deep sedation predicted the 28-day survival of patients with moderate to severe ARDS.

Conflict of interest statement

All the authors declare that they have no conflicts of interest.

Copyright © 2020 Yongpeng Xie et al.

Figures

Figure 1
Figure 1
The time stamp for each sedation stage.
Figure 2
Figure 2
Parameter variation in ARDS patients under moderate to severe sedation. (a) MP. (b) RR. (c) Ptp. (d) Cst. (e) PF. Results were expressed as mean ± standard deviation (x ± s) of at least three different measurements. ∗P < 0.05, ∗∗∗∗P < 0.0001.
Figure 3
Figure 3
Correlation between ΔMP and ΔRR, ΔPtp, ΔCst, and ΔPF. (a) ΔMP vs. ΔRR. (b) ΔMP vs. ΔPtp. (c) ΔMP vs. vs. ΔCst. (d) ΔMP vs. ΔPF. Results were expressed as mean ± standard deviation (x ± s) of at least three different measurements.
Figure 4
Figure 4
MP and 28-day survival curve in patients with ARDS.

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Source: PubMed

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