Observational studyCritical care (London, England)2019
Effects of sedatives and opioids on trigger and cycling asynchronies throughout mechanical ventilation: an observational study in a large dataset from critically ill patients.
Observational study in Critical care (London, England), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03451461 (Asynchronies During Mechanical Ventilation), which is not on this map. Cited by 15 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Asynchronies During Mechanical Ventilation: Factors Related
Who cites it
15 citing papers in PubMed, 58 citations in OpenAlex.
- Methodological development of the remote ventilate view platform for real-time monitoring of patient-ventilator asynchrony and respiratory parameters in severe pneumonia patients.Journal of intensive medicine · 2025Article
- Scheduled intravenous opioids.Intensive care medicine · 2023Article
- Automated evaluation of typical patient-ventilator asynchronies based on lung hysteretic responses.Biomedical engineering online · 2023Article
- Ineffective Effort in Patients With Acute Brain Injury Undergoing Invasive Mechanical Ventilation.Respiratory care · 2023Article
- A Focused Review of the Initial Management of Patients with Acute Respiratory Distress Syndrome.Journal of clinical medicine · 2023Article
- Modern Sedation and Analgesia Strategies in Neurocritical Care.Current neurology and neuroscience reports · 2023Review
- Excess Tidal Volume Ventilation in Critically Ill Adults Receiving Adaptive Pressure Control: A Cohort Study.Annals of the American Thoracic Society · 2022Article
- Reverse Triggering: An Introduction to Diagnosis, Management, and Pharmacologic Implications.Frontiers in pharmacology · 2022Review
- Virtual Reality-Based Early Neurocognitive Stimulation in Critically Ill Patients: A Pilot Randomized Clinical Trial.Journal of personalized medicine · 2021Article
- Respiratory Support Adjustments and Monitoring of Mechanically Ventilated Patients Performing Early Mobilization: A Scoping Review.Critical care explorations · 2021Article
- Duration of diaphragmatic inactivity after endotracheal intubation of critically ill patients.Critical care (London, England) · 2021Observational
- Cognitive phenotypes 1 month after ICU discharge in mechanically ventilated patients: a prospective observational cohort study.Critical care (London, England) · 2020Observational
- Patient-ventilator asynchrony in acute brain-injured patients: a prospective observational study.Annals of intensive care · 2020Article
- Outcomes of ventilatory asynchrony in patients with inspiratory effort.Revista Brasileira de terapia intensiva · 2020Article
- Risk Factors for Patient-Ventilator Asynchrony and Its Impact on Clinical Outcomes: Analytics Based on Deep Learning Algorithm.Frontiers in medicine · 2020Article
Corrections and comments
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Authors and funding
18 authors at 7 institutions in 5 countries.
Funding
Abstract
backgroundIn 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.
methodsThis 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.
resultsIn 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 < 0.0001) in sedatives-only days. However, on days classified as sedatives-plus-opioids, higher sedative doses and deeper sedation had more IEE (p < 0.0001) and higher AI (p = 0.0004). Opioid dosing was inversely associated with overall asynchronies (p < 0.001) without worsening sedation levels into morbid ranges.
conclusionsSedatives, 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.
trial registrationClinicalTrial.gov, NCT03451461.
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