Effects of Propofol on Respiratory Drive and Patient-ventilator Synchrony during Pressure Support Ventilation in Postoperative Patients： A Prospective Study

作     者：Ling Liu Ai-Ping Wu Yi Yang Song-Qiao Liu Ying-Zi Huang Jian-Feng Xie Chun Pan Cong-Shan Yang Hai-Bo Qiu Liu Ling;Wu Ai-Ping;Yang Yi;Liu Song-Qiao;Huang Ying-Zi;Xie Jian-Feng;Pan Chun;Yang Cong-Shan;Qiu Hai-Bo

作者机构：Department of Critical Care Medicine School of Medicine Nanjing Zhongda Hospital Southeast University Nanjing Jiangsu 210009 China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2017年第130卷第10期

页      面：1155-1160页

核心收录：

学科分类：1002[医学-临床医学] 100217[医学-麻醉学] 10[医学] 

基　　金：supported by grants from Clinical Science and Technology Specific Projects of Jiangsu Province 国家自然科学基金 

主　　题：Electrical Activity of Diaphragm Patient-ventilator Synchrony Propofol Respiratory Drive 

摘      要：Background： Propofol is increasingly nsed during partial support mechanical ventilation such as pressure support ventilation （PSV） in postoperative patients. However breathing pattern, respiratory drive, and patient-ventilator synchrony are affected by the sedative used and the sedation depth. The present study aimed to evaluate the physiologic effects of varying depths ofpropofbl sedation oll respiratory drive and patient-ventilator synchrony during PSV in postoperative patients. Methods： Eight postoperative patients receiving PSV for 〈24 h were enrolled. Propofol was administered to achieve and maintain a Ramsay score of 4, and the inspiratory pressure support was titrated to obtain a tidal volume （VT） of 6-8 ml/kg. Then, tile propolbl dose was reduced to achieve and maintain a Ramsay score of 3 and then 2. At each Ramsay level, the patient underwent 30-rain trials of PSV. We measured the electrical activity of the diaphragm, flow, airway presstlre, neuro-ventilatory efficiency （NVE）, and patient-ventilator synchrony. Results： Increasing the depth of sedation reduced the peak and mean electrical activity of the diaphragm, which suggested a decrease in respiratory drive, while VT remained unchanged. The NVE increased with an increase in the depth of sedation. Minute ventilation and inspiratory duty cycle decreased with an increase in the depth of sedation, but this only achieved statistical significance between Ramsay 2 and both Ramsay 4 and 3 （P 〈 0.05）. The ineffective triggering index increased with increasing sedation depth （9.5 -4- 4.0%, 6.7 - 2.0%, and 4.2-2.1% for Ramsay 4, 3, and 2, respectively） and achieved statistical significance between each pair of depth of sedation （P 〈 0.05）. The depth of sedation did not affect gas exchange. Conclusions： Propofol inhibits respiratory drive and deteriorates patient-ventilator synchrony to tile extent that varies with tile depth of sedation. Propolbl has less effect on breathing pattern and has no effect on VT and ga