Study on analgesia and sedation guided by P0.1 to reduce lung injury of patients with severe acute respiratory distress syn-drome
Objective To explore the relationship between analgesia and sedation guided by P0.1 and the reduction lung injury in patients with severe acute respiratory distress syndrome(ARDS),and to guide mechanical ventilation for patients with severe ARDS.Methods A total of 70 patients with severe ARDS who received mechanical ventilation in ICU of Shaoxing people's Hospital from October 2021 to June 2023 were randomly divided into control group and experimental group,each with 35 cases.Within 48 hours of mechanical ventilation,both groups received deep analgesia and sedation to eliminate spontaneous breathing.During the 49-168 h of mechanical ventilation,the control group received analgesia and sedation treatment to maintain Richmond Agitation-Sedation Scale(RASS)scores of-2-0,while in the experimental group,P0.1 was used as the quantitative index of respiratory effort,which was maintained at 1-3.5 cmH2O(1 cmH2O=0.098 kPa)to guide analgesia and sedation.The venous blood of patients in the two groups were taken at 48,120 and 168 h after mechanical ventilation,and the levels of pulmonary surfactant protein D(SP-D)and serum krebs von den lungen-6(KL-6)were detected by ELISA.P0.1 and oxygenation index values of patients in the two groups were observed at 48,120,and 168 hours,and the mortality of patients in the two groups was compared.Results The serum SP-D levels of the experimental group were lower than those of the control group at 120 hours[(102.73±19.25)ng/mL vs.(113.57± 21.19)ng/mL]and 168 hours[(91.28±27.47)ng/mL vs.(106.35±28.47)ng/mL]of mechanical ventilation,and the differences were statistically significant(both P＜0.05).There was no significant difference in the basic levels of SP-D(at 48 h)and KL-6(at 48,120 and 168 h)between the two groups(all P＞0.05).The P0.1 of the experimental group was lower than that of the control group at 48 hours[(1.83±0.52)cmH2O vs.(4.05±0.62)cmH2O],120 hours[(2.28± 0.46)cmH2O vs.(4.31±0.72)cmH2O],and 168 hours[(2.94±0.48)cmH2O vs.(4.23±1.06)cmH2O]of mechanical ventilation,and the differences were statistically significant(all P＜0.01).There were no statistically significant differences in oxygenation index at 48,120,and 168 hours between the two groups(all P＞0.05).There was no statistically significant difference in mortality between the two groups(P＞0.05).Conclusion Analgesia and sedation guided by P0.1 is beneficial to the imple-mentation of lung protective ventilation strategy in patients with severe ARDS,which is helpful to reduce lung injury in patients with severe ARDS.
万方数据
维普
