Correlation of occlusion pressure with sedation in non-neurocritical patients
Main Article Content
Keywords
Critcal Care, Respiration, Artificial, Intensive Care Units, Sedation
Abstract
Background: Mechanical ventilation is used in conjunction with sedation, which is titrated with clinical scales based on the therapeutic objective. It is difficult to find a reliable marker of respiratory drive in critically ill patients, so determining the correlation between the depth of sedation and airway occlusion pressure at 100 milliseconds (P0.1) would help titrate the depth of sedation and regulate respiratory drive.
Objective: To determine whether P0.1 correlates with the depth of sedation measured with a clinical RASS scale and the bispectral index.
Material and methods: A prospective cohort study was conducted with non-neurocritical patients undergoing mechanical ventilation from April 1, 2023, to September 30, 2023, in a tertiary care hospital in Mexico City.
Results: 229 patients were included. Pearson's correlation was applied comparing the simultaneously measured BIS with the P0.1, finding a correlation of 0.64 with a p < 0.001. The correlation of this with RASS was 0.43, with propofol -0.18, with benzodiazepines -0.036, with buprenorphine -0.25, and with dexmedetomidine 0.051
Conclusion: There was a stronger correlation of P0.1 with the BIS compared with the RASS and the doses of the drugs used. It could be used for titrating sedation in non-neurocritical patients.
References
1. Carteaux G, Parfait M, Combet M, et al. Patient-Self Inflicted Lung Injury: A Practical Review. J Clin Med. 2021 Jun 21;10(12):2738. doi: 10.3390/jcm10122738.
2. Goligher EC, Dres M, Fan E, et al. Mechanical Ventilation-induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes. Am J Respir Crit Care Med. 2018 Feb;197(2):204-13. doi:10.1164/rccm.201703-0536OC
3. Tocalini P, Vicente A, Carballo JM, et al. Disfunción diafragmática asociada a la ventilación mecánica invasiva en pacientes adultos críticamente enfermos. Rev Fac Cien Med Univ Nac Cordoba. 2021 Jun 28;78(2):197-206. Spanish. doi: 10.31053/1853.0605.v78.n2.28458.
4. Saavedra SN, Barisich PVS, Maldonado JBP, et al. Asynchronies during invasive mechanical ventilation: narrative review and update. Acute Crit Care. 2022 Nov;37(4):491-501. doi: 10.4266/acc.2022.01158.
5. Yoshida T, Torsani V, Gomes S, et al. Spontaneous Effort Causes Occult Pendelluft during Mechanical Ventilation. Am J Respir Crit Care Med. 2013 Dec 15;188(12):1420-7. doi: 10.1164/rccm.201303-0539OC
6. Telias I, Brochard L, Goligher EC. Is my patient's respiratory drive (too) high? Intensive Care Med. 2018 Nov;44(11):1936-1939. doi: 10.1007/s00134-018-5091-2.
7. Telias I, Junhasavasdikul D, Rittayamai N, et al. Airway Occlusion Pressure As an Estimate of Respiratory Drive and Inspiratory Effort during Assisted Ventilation. Am J Respir Crit Care Med. 2020 May 1;201(9):1086-98. doi: 10.1164/rccm.201907-1425OC
8. Brochard L, Slutsky A, Pesenti A. Mechanical Ventilation to Minimize Progression of Lung Injury in Acute Respiratory Failure. Am J Respir Crit Care Med. 2017 Feb 15; 195(4):438-442. doi: 10.1164/rccm.201605-1081CP
9. Alberti A, Gallo F, Fongaro A, et al. P0.1 is an useful parameter in setting the level of pressure support ventilation. Intensive Care Med. 1995 Jul;21(7):547-53. doi: 10.1007/BF01700158
10. Mancebo J, Albaladejo P, Touchard D, et al. Airway Occlusion Pressure to Titrate Positive End-expiratory Pressure in Patients with Dynamic Hyperinflation. Anesthesiology. 2000 jul 1;93(1):81-90. doi: 10.1097/00000542-200007000-00016
11. Schepens T, Dianti J. Diaphragm protection: what should we target? Curr Opin Crit Care. 2020 Feb;26(1):35-40. doi: 10.1097/MCC.0000000000000683
12. Marongiu I, Slobod D, Leali M, et al. Clinical and Experimental Evidence for Patient Self-Inflicted Lung Injury (P-SILI) and Bedside Monitoring. J Clin Med. 2024 Jul 10;13(14):4018. doi: 10.3390/jcm13144018.
13. von Düring S, Parhar KKS, Adhikari NKJ, et al. Understanding ventilator-induced lung injury: The role of mechanical power. J Crit Care. 2025 Feb;85:154902. doi: 10.1016/j.jcrc.2024.154902.
14. Lewis K, Balas MC, Stollings JL, et al. A Focused Update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2025 Mar 1;53(3):e711-e727. doi: 10.1097/CCM.0000000000006574.
15. Turrubiates Hernández, Mora Martínez, Reyes Pérez, et al. Lesión pulmonar y diafragmática inducida por la ventilación mecánica: conceptos básicos y revisión de las estrategias de manejo, Acta Colombiana de Cuidado Intensivo, 2025;25(1) 82-90, doi:10.1016/j.acci.2024.08.005.
16. Sato R, Hasegawa D, Hamahata NT, et al. The predictive value of airway occlusion pressure at 100 msec (P0.1) on successful weaning from mechanical ventilation: A systematic review and meta-analysis. J Crit Care. 2021 Jun;63:124-132. doi: 10.1016/j.jcrc.2020.09.030.
17. Kassis EB, Beitler JR, Talmor D. Lung-protective sedation: moving toward a new paradigm of precision sedation. Intensive Care Med. 2023 Jan;49(1):91-94. doi: 10.1007/s00134-022-06901-z.
18. Rashidi M, Molavynejad S, Javadi N, et al. The effect of using Richmond agitation and sedation scale on hospital stay, ventilator dependence, and mortality rate in ICU inpatients: a randomised clinical trial. J Res Nurs. 2020 Dec;25(8):734-746. doi: 10.1177/1744987120943921.
19. Yamada J, Hazama D, Tachihara M, et al. The utility of bispectral index monitoring in flexible bronchoscopy: A single-center, retrospective observational study. Thorac Cancer. 2022 Nov;13(21):3052-3057. doi: 10.1111/1759-7714.14658.
20. Mathur S, Patel J, Goldstein S, et al. Bispectral Index. 2023 Nov 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–.
21. Heavner MS, Gorman EF, Linn DD, et al. Systematic review and meta-analysis of the correlation between bispectral index (BIS) and clinical sedation scales: Toward defining the role of BIS in critically ill patients. Pharmacotherapy. 2022 Aug;42(8):667-676. doi: 10.1002/phar.2712.
22. Manning J, Chiasson M. Does Bispectral Index Monitoring Belong in the Intensive Care Unit Setting?: A Narrative Review of Evidence. Dimens Crit Care Nurs. 2025 Sep-Oct 01;44(5):231-238. doi: 10.1097/DCC.0000000000000713.
23. Cheung CW, Irwin MG, Chiu WK, et al. A study to assess the value of bispectral analysis in intravenous sedation with midazolam during third molar surgery under local anaesthesia. Anaesthesia. 2008 Dec;63(12):1302-8. doi: 10.1111/j.1365-2044.2008.05652.x.
24. Cheriyan T, Bai K, Bayyapureddy S, et al. Effect of bispectral index on intra-operative awareness: A meta-analysis of randomized controlled studies. Saudi J Anaesth. 2024 Jul-Sep;18(3):360-370. doi: 10.4103/sja.sja_74_24.
25. Zheng J, Gao Y, Xu X, et al. Correlation of bispectral index and Richmond agitation sedation scale for evaluating sedation depth: a retrospective study. J Thorac Dis. 2018 Jan;10(1):190-195. doi: 10.21037/jtd.2017.11.129.
26. Dzierba AL, Khalil AM, Derry KL, Madahar P, Beitler JR. Discordance Between Respiratory Drive and Sedation Depth in Critically Ill Patients Receiving Mechanical Ventilation. Crit Care Med. 2021 Dec 1;49(12):2090-2101. doi: 10.1097/CCM.0000000000005113.
27. Pérez-García S, Lozano-Carrascal N, Ruiz-Roca JA, et al. Evaluation of endovenous sedation using BIS monitoring in dentistry. A systematic review. Med Oral Patol Oral Cir Bucal. 2020 Jul 1;25(4):e439-e448. doi: 10.4317/medoral.22884.
28. de Vries HJ, Tuinman PR, Jonkman AH, et al. Performance of Noninvasive Airway Occlusion Maneuvers to Assess Lung Stress and Diaphragm Effort in Mechanically Ventilated Critically Ill Patients. Anesthesiology. 2023 Mar 1;138(3):274-288. doi: 10.1097/ALN.0000000000004467
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