The influence of drugs used for sedation during mechanical ventilation on respiratory pattern during unassisted breathing and assisted mechanical ventilation: a physiological systematic review and meta-analysisResearch in context

Summary: Background: Sedation management has a major impact on outcomes in mechanically ventilated patients, but sedation strategies do not generally consider the differential effects of different sedatives on respiration and respiratory pattern. A systematic review was undertaken to quantitatively...

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Main Authors: Danica Quickfall, Michael C. Sklar, George Tomlinson, Ani Orchanian-Cheff, Ewan C. Goligher
Format: Article
Language:English
Published: Elsevier 2024-02-01
Series:EClinicalMedicine
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2589537023005941
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author Danica Quickfall
Michael C. Sklar
George Tomlinson
Ani Orchanian-Cheff
Ewan C. Goligher
author_facet Danica Quickfall
Michael C. Sklar
George Tomlinson
Ani Orchanian-Cheff
Ewan C. Goligher
author_sort Danica Quickfall
collection DOAJ
description Summary: Background: Sedation management has a major impact on outcomes in mechanically ventilated patients, but sedation strategies do not generally consider the differential effects of different sedatives on respiration and respiratory pattern. A systematic review was undertaken to quantitatively summarize the known effects of different classes of drugs used for sedation on respiratory pattern during both spontaneous breathing and assisted mechanical ventilation. Methods: This was a systematic review and meta-analysis conducted using Ovid MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials up to June 2020 to retrieve studies that measured respiratory parameters before and after the administration of opioids, benzodiazepines, intravenous and inhaled anaesthetic agents, and other hypnotic agents (PROSPERO #CRD42020190017). A random-effects meta-analytic model was employed to estimate the mean percentage change in each of the respiratory indices according to medication exposure with and without mechanical ventilation. Risk of bias was assessed using the Cochrane risk of bias assessment tools. Findings: Fifty-one studies were included in the analysis. Risk of bias was generally deemed to be low for most studies. Respiratory rate decreased with the administration of opioids in both non-ventilated patients (18% decrease, 95% CI 12–24%) and ventilated patients (26% decrease, 95% CI 15–37%) and increased with inhaled anaesthetics in non-ventilated patients (83% increase, 95% CI 49–118%) and ventilated patients (50% increase, 28–72%). In non-ventilated patients, tidal volume decreased following administration of inhaled aesthetics (55% decrease, 95% CI 25–86%), propofol (36% decrease, 95% CI 20–52%), and benzodiazepines (28% decrease, 95% CI 17–40%); in patients receiving assisted mechanical ventilation, tidal volume was not significantly affected by sedation. Administration of other hypnotic agents was not associated with changes in respiratory rate or tidal volume. Interpretation: Different classes of drugs used for sedation exert differential effects on respiratory pattern, and this may influence weaning and outcomes in mechanically ventilated patients. Funding: This study did not receive any funding support.
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spelling doaj.art-6c8a50733fc747839cf51ede645270902024-01-23T04:16:05ZengElsevierEClinicalMedicine2589-53702024-02-0168102417The influence of drugs used for sedation during mechanical ventilation on respiratory pattern during unassisted breathing and assisted mechanical ventilation: a physiological systematic review and meta-analysisResearch in contextDanica Quickfall0Michael C. Sklar1George Tomlinson2Ani Orchanian-Cheff3Ewan C. Goligher4Department of Critical Care Medicine, University of Calgary, Calgary, CanadaUnity Health, Toronto, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, CanadaDepartment of Medicine, University Health Network, Toronto, CanadaLibrary and Information Services, University Health Network, Toronto, CanadaInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Department of Medicine, University Health Network, Toronto, Canada; Toronto General Hospital Research Institute, Toronto, Canada; Department of Physiology, University of Toronto, Toronto, Canada; Corresponding author. Toronto General Hospital, 585 University Ave., 9-MaRS-9024, Toronto, ON, M5G 2N2, Canada.Summary: Background: Sedation management has a major impact on outcomes in mechanically ventilated patients, but sedation strategies do not generally consider the differential effects of different sedatives on respiration and respiratory pattern. A systematic review was undertaken to quantitatively summarize the known effects of different classes of drugs used for sedation on respiratory pattern during both spontaneous breathing and assisted mechanical ventilation. Methods: This was a systematic review and meta-analysis conducted using Ovid MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials up to June 2020 to retrieve studies that measured respiratory parameters before and after the administration of opioids, benzodiazepines, intravenous and inhaled anaesthetic agents, and other hypnotic agents (PROSPERO #CRD42020190017). A random-effects meta-analytic model was employed to estimate the mean percentage change in each of the respiratory indices according to medication exposure with and without mechanical ventilation. Risk of bias was assessed using the Cochrane risk of bias assessment tools. Findings: Fifty-one studies were included in the analysis. Risk of bias was generally deemed to be low for most studies. Respiratory rate decreased with the administration of opioids in both non-ventilated patients (18% decrease, 95% CI 12–24%) and ventilated patients (26% decrease, 95% CI 15–37%) and increased with inhaled anaesthetics in non-ventilated patients (83% increase, 95% CI 49–118%) and ventilated patients (50% increase, 28–72%). In non-ventilated patients, tidal volume decreased following administration of inhaled aesthetics (55% decrease, 95% CI 25–86%), propofol (36% decrease, 95% CI 20–52%), and benzodiazepines (28% decrease, 95% CI 17–40%); in patients receiving assisted mechanical ventilation, tidal volume was not significantly affected by sedation. Administration of other hypnotic agents was not associated with changes in respiratory rate or tidal volume. Interpretation: Different classes of drugs used for sedation exert differential effects on respiratory pattern, and this may influence weaning and outcomes in mechanically ventilated patients. Funding: This study did not receive any funding support.http://www.sciencedirect.com/science/article/pii/S2589537023005941Mechanical ventilationSedationControl of breathingRespiratory failure
spellingShingle Danica Quickfall
Michael C. Sklar
George Tomlinson
Ani Orchanian-Cheff
Ewan C. Goligher
The influence of drugs used for sedation during mechanical ventilation on respiratory pattern during unassisted breathing and assisted mechanical ventilation: a physiological systematic review and meta-analysisResearch in context
EClinicalMedicine
Mechanical ventilation
Sedation
Control of breathing
Respiratory failure
title The influence of drugs used for sedation during mechanical ventilation on respiratory pattern during unassisted breathing and assisted mechanical ventilation: a physiological systematic review and meta-analysisResearch in context
title_full The influence of drugs used for sedation during mechanical ventilation on respiratory pattern during unassisted breathing and assisted mechanical ventilation: a physiological systematic review and meta-analysisResearch in context
title_fullStr The influence of drugs used for sedation during mechanical ventilation on respiratory pattern during unassisted breathing and assisted mechanical ventilation: a physiological systematic review and meta-analysisResearch in context
title_full_unstemmed The influence of drugs used for sedation during mechanical ventilation on respiratory pattern during unassisted breathing and assisted mechanical ventilation: a physiological systematic review and meta-analysisResearch in context
title_short The influence of drugs used for sedation during mechanical ventilation on respiratory pattern during unassisted breathing and assisted mechanical ventilation: a physiological systematic review and meta-analysisResearch in context
title_sort influence of drugs used for sedation during mechanical ventilation on respiratory pattern during unassisted breathing and assisted mechanical ventilation a physiological systematic review and meta analysisresearch in context
topic Mechanical ventilation
Sedation
Control of breathing
Respiratory failure
url http://www.sciencedirect.com/science/article/pii/S2589537023005941
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