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Review of A Large Clinical Series: Sedation and Analgesia Usage with Airway Pressure Release and Assist-control Ventilation for Acute Lung Injury

Division of Pulmonary and Critical Care Medicine, University of Maryland Medical System, Baltimore, Maryland,

Priyanka Khatri, MBBS

Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India

Pedro A. Mendez-Tellez, MD

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland

Carl Shanholtz, MD

Dale M. Needham, MD, PhD

Division of Pulmonary and Critical Care Medicine, , Johns Hopkins University, Baltimore, Maryland, dale.needham{at}jhmi.edu

Background: Our objective was to compare sedative and analgesic doses, agents, and sedation status in patients with airway pressure release ventilation (APRV) versus assist-control (AC) ventilation on the first day after acute lung injury diagnosis.

Methods: Observational study at 3 teaching hospitals. Results: Of 240 patients, 165 received APRV or AC ventilation on day 1 (17 APRV, 148 AC). The median Acute Physiology and Chronic Health Evaluation II score was lower in the APRV versus AC group [17 (14-20) vs. 25 (21-32), P < .001]. Median total doses of sedatives and analgesics were lower in APRV versus AC (29 vs. 98 mg of midazolam-equivalents, P < .001) and (1200 vs. 2400 mcg of fentanylequivalents, P = .006). APRV patients were less sedated versus AC (median Richmond Agitation-Sedation Scale —2 vs. —4, P < .002). Conclusions: APRV may be associated with decreased sedation and analgesia medications and improved sedation status. Differences in the patients receiving APRV versus AC ventilation may have contributed to this conclusion. Further investigation is needed.

Key Words: acute respiratory distress syndrome • analgesics • airway pressure release ventilation • assist control ventilation • sedatives

This version was published on November 1, 2008

Journal of Intensive Care Medicine, Vol. 23, No. 6, 376-383 (2008)
DOI: 10.1177/0885066608324293


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