Comparison of the effects of esketamine/midazolam and remifentanil/midazolam on respiratory mechanics in mechanically ventilated patients with acute respiratory distress syndrome.

Abstract

Esketamine exerts analgesic effects and has pharmacological properties of bronchodilation and elevation of mean arterial pressure, making it an interesting analgesic agent for patients with ARDS. Therefore, we conducted a randomized controlled trial comparing the effects of esketamine/midazolam and remifentanil/midazolam on respiratory mechanics and oxygenation in mechanically ventilated patients with ARDS. In this prospective, randomized, controlled study, patients with ARDS who were undergoing mechanical ventilation were randomly assigned to receive either remifentanil/midazolam (n = 25) or esketamine/midazolam (n = 25). Both groups maintained equivalent levels of sedation and analgesia. The primary outcomes were airway resistance (Raw) and static respiratory system compliance (Cst) at 24, 48, and 72 h post-medication administration. Plateau Pressure (Pplat), peak airway pressure (Ppeak), hemodynamic parameters, mechanical ventilation duration, and ICU length of stay were also recorded. Cst at 72 h post-medication in esketamine group (49.8 ± 13.8) was higher than that in control group (42.4 ± 11.9) (P 0.05). At 72 h post-medication, both Pplat and Ppeak in the esketamine group [(15.6 ± 3.1); (25.7 ± 3.8)] were significantly lower than those in the control group[(17.7 ± 4.2); (28.5 ± 4.7)] (P 0.05). Esketamine/midazolam leads to improved in Cst and PaO2/FiO2 ratio compared to remifentanil/midazolam in mechanically ventilated patients with ARDS. This study was registered at Chinese Clinical Trial Registry (ChiCTR2300070733) on April 21, 2023. URL: https://www.chictr.org.cn/ .