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

作者：Dujuan Qiao, Wei Liu, Huanjia Xue, Rui Liu, Ya Gao, Jingzhi Dong, Wei Wu, Junkai Feng, Min Li, Linong Yao · 发表于：BMC Anesthesiology · 年份：2025 · DOI：10.1186/s12871-025-03211-x · 被引用次数：6 · 研究领域：Respiratory Support and Mechanisms、Intensive Care Unit Cognitive Disorders、Anesthesia and Sedative Agents

Abstract Background 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. Methods 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 (R aw ) and static respiratory system compliance (C st ) at 24, 48, and 72 h post-medication administration. Plateau Pressure (P plat ), peak airway pressure (P peak ), hemodynamic parameters, mechanical ventilation duration, and ICU length of stay were also recorded. Results C st 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). There was no significant difference in R aw at 24 h, 48 h and 72 h post-medication between the two groups ( P > 0.05). At 72 h post-medication, both P plat and P peak 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....