Abstract
Purpose
To evaluate the effects of sedation with sufentanil on respiratory drive, respiratory pattern, and gas exchange of critically ill patients during pressure support ventilation.
Methods
In this prospective observational cohort study, we observed 12 adult patients receiving partial ventilatory support for acute respiratory failure. Each subject received a continuous infusion of sufentanil at 0.2 to 0.3 μg·kg−1·hr−1 to obtain a modified Ramsay sedation score between 2 and 3. In basal conditions and at variable distance from the beginning of the sufentanil infusion (10’, 30’, 60’, 120’, 24 hr) we evaluated gas exchange, hemodynamic variables, respiratory rate (RR), tidal volume (TV), respiratory pattern, respiratory drive (P0.1) and inspiratory impedance of the respiratory system [P0.1 /TV/inspiratory time (Ti)].
Results
The continuousiv administration of 0.2 to 0.3 μg·kg−1·hr−1 of sufentanil resulted in the desired level of sedation. No significant heart rate, heart rhythm and blood pressure changes were observed. Sufentanil infusion did not affect TV, minute volume, Ti/inspiratory duty cycle, RR, P0.1, P0.1 /TV/Ti and gas exchange did not change significantly over the study period.
Conclusion
A continuous infusion of sufentanil induces “awake” sedation with no detectable effects on respiratory variables in critically ill patients during partial ventilatory support.
Résumé
Objectif
Évaluer les effets de la sédation avec sufentanil sur la commande respiratoire, le rythme respiratoire et les échanges gazeux chez les grands malades pendant l’assistance ventilatoire inspiratoire.
Méthode
Nous avons observé 12 patients adultes sous assistance ventilatoire inspiratoire pour insuffisance respiratoire aiguë dans le cadre d’une étude prospective par observation. Chaque sujet a reçu une perfusion continue de 0,2 à 0,3 μg·kg−1·h−1 de sufentanil pour obtenir un score de sédation de Ramsay modifié entre 2 et 3. Au départ et à intervalles variables après le début de la perfusion de sufentanil (10′, 30′, 60′, 120′, 24 h), nous avons évalué les échanges gazeux, les variables hémodynamiques, la fréquence respiratoire (FR), le volume courant (VC), le rythme respiratoire, la commande respiratoire (P0, 1) et l’impédance inspiratoire du système respiratoire [P0, 1/TV/temps d’inspiration (Ti)].
Résultats
L’administration iv continue de 0,2 à 0,3 μg·kg−1·h−1 de sufentanil a produit le niveau désiré de sédation. Aucune modification significative de la fréquence cardiaque, du rythme cardiaque et de la tension artérielle n’a été observée. Le sufentanil n’a pas affecté le VC, la ventilation- minute, le Ti/cycle inspiratoire complet, le RR, la P0, 1, la P0; 1/VC/Ti et les échanges gazeux n’ont pas changé de façon significative au cours de l’étude.
Conclusion
Une perfusion continue de sufentanil induit une sédation «vigile» sans effets détectables sur les variables respiratoires chez les grands malades pendant l’assistance ventilatoire inspiratoire.
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Conti, G., Arcangeli, A., Antonelli, M. et al. Sedation with sufentanil in patients receiving pressure support ventilation has no effects on respiration: a pilot study. Can J Anesth 51, 494–499 (2004). https://doi.org/10.1007/BF03018315
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DOI: https://doi.org/10.1007/BF03018315