title: Review of a large clinical series: sedation and analgesia usage with airway pressure release and assist-control ventilation for acute lung injury.
abstract: BACKGROUND
  Our objective was to compare sedative and analgesic doses, agents, and sedation status in patients with airway pressure release ventilation (APRV) versus assist-control (AC) ventilation on the first day after acute lung injury diagnosis.
  
  
  METHODS
  Observational study at 3 teaching hospitals.
  
  
  RESULTS
  Of 240 patients, 165 received APRV or AC ventilation on day 1 (17 APRV, 148 AC). The median Acute Physiology and Chronic Health Evaluation II score was lower in the APRV versus AC group [17 (14-20) vs. 25 (21-32), P < .001]. Median total doses of sedatives and analgesics were lower in APRV versus AC (29 vs. 98 mg of midazolam-equivalents, P < .001) and (1200 vs. 2400 mcg of fentanyl equivalents, P = .006). APRV patients were less sedated versus AC (median Richmond Agitation-Sedation Scale -2 vs. -4, P < .002).
  
  
  CONCLUSIONS
  APRV may be associated with decreased sedation and analgesia medications and improved sedation status. Differences in the patients receiving APRV versus AC ventilation may have contributed to this conclusion. Further investigation is needed.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Eddy
authors.initials: E
authors.lastname: Fan
authors.forename: Priyanka
authors.initials: P
authors.lastname: Khatri
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Mendez-Tellez
authors.forename: Carl
authors.initials: C
authors.lastname: Shanholtz
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000698:Analgesia; D000701:Analgesics, Opioid; D016292:Procedural Sedation; D045422:Continuous Positive Airway Pressure; D005260:Female; D005283:Fentanyl; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011175:Positive-Pressure Respiration; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000145:classification / Q000628:therapy*
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D008874:Midazolam; D005283:Fentanyl