title: Combination of clonidine sedation and spontaneous breathing-pressure support upon acute respiratory distress syndrome: a feasibility study in four patients.
abstract: BACKGROUND
  As alpha-2 agonists preserve ventilator drive, patients presenting with acute respiratory distress syndrome (ARDS, Pa02/FiO2 < 200) were managed using sedation with an alpha-2 agonist, clonidine, combined to spontaneous ventilation (SV) + pressure support ventilation (PS).
  
  
  METHODS
  Sedation was provided by an alpha-2 agonist, clonidine 1-2 microg x kg(-1( x h(-1), without bolus administration, and supplemented with a neuroleptic, loxapine, if needed. Four patients presenting with ARDS were managed with pressure support ventilation (PS = 8 cm H20,rarely 10-12 cm H20) and high PEEP (10-20 cm H20). Energy requirements were minimized, if appropriate, with hypothermia caused by extra-renal replacement therapy or intentional hypothermia (35-36 degrees C). Repeated echocardiographic examinations revealed no right ventricular failure.
  
  
  RESULTS
  Recovery of ARDS, i.e. sustained increase of P/F > 200 for > 24 h, was observed, over 2-5 days.
  
  
  CONCLUSIONS
  Use of an alpha-2 agonist as first-line sedative agent led to absence of respiratory depression and spontaneous ventilation. Upon ARDS, the lowered intrathoracic pressure observed with SV+PSV allowed one to recruit alveoli with high levels of PEEP, without impairing right ventricle function.
authors: Critical Care, Epinal Hospital, Epinal, France.
authors: C
authors: C
authors: Pichot
authors: A
authors: A
authors: Picoche
authors: M I
authors: MI
authors: Saboya-Steinbach
authors: R
authors: R
authors: Rousseau
authors: J
authors: J
authors: de Guys
authors: M
authors: M
authors: Lahmar
authors: D
authors: D
authors: Thomas
authors: M
authors: M
authors: Guerry
authors: J M
authors: JM
authors: Lalot
authors: R
authors: R
authors: Monarchi
authors: M
authors: M
authors: Galliez
authors: M
authors: M
authors: Ghignone
authors: L
authors: L
authors: Quintin
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000009:adverse effects; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents; D003000:Clonidine / Q000009:adverse effects; D016292:Procedural Sedation / Q000009:adverse effects; D005240:Feasibility Studies; D006801:Humans; D007035:Hypothermia / Q000209:etiology / Q000628:therapy; D008152:Loxapine; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration / Q000379:methods*; D011859:Radiography; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D014150:Antipsychotic Agents; D008152:Loxapine; D003000:Clonidine; D010100:Oxygen