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. 2024 Jan 5:68:102417.
doi: 10.1016/j.eclinm.2023.102417. eCollection 2024 Feb.

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-analysis

Danica Quickfall  1 , Michael C Sklar  2   3 , George Tomlinson  4 , Ani Orchanian-Cheff  5 , Ewan C Goligher  3   4   6   7
Affiliations

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-analysis

Danica Quickfall et al. EClinicalMedicine. .

Abstract

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.

Keywords: Control of breathing; Mechanical ventilation; Respiratory failure; Sedation.

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Conflict of interest statement

Dr. Goligher reports receiving grants from the Canadian Institutes of Health Research and National Sanitarium Association; consulting fees from Lungpacer Medical, Stimit LLC, and Bioage; honoraria for lectures from Vyaire, Draeger, and Getinge; advisory board participation for Getinge (current) and Lungpacer (previous); and receipt of equipment for research from Timpel and Lungpacer.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram outlining study inclusion.
Fig. 2
Fig. 2
Influence of different sedative classes on tidal volume and respiratory rate in patients who are on mechanical ventilation and not on mechanical ventilation. Dots are point estimates for the mean and bars span 95% confidence intervals for the mean.
See this image and copyright information in PMC

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