Impact of selected sedative agents on inflammatory immune response and clinical outcomes in mechanically-ventilated patients with acute exacerbation of chronic obstructive pulmonary disease complicated by sepsis

Abstract

Purpose: To determine the diverse impact of dexmedetomidine (Dex), propofol (Pro), and midazolam (Mid) sedation on immune response, inflammation, and treatment effects in mechanically-ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated by sepsis. Methods: 90 patients with AECOPD complicated by sepsis who were undergoing mechanical ventilation in Xuzhou First People's Hospital, China were randomly divided into Pro, Dex and Mid groups, with 30 patients in each group. Prior to the initiation of mechanical ventilation treatment, participants in each group received a slow intravenous injection of 10 - 40 mg of Pro, Dex (1 μg/kg) or Mid (0.05 mg/kg). Throughout the treatment period, each group underwent continuous intravenous infusion, with Pro, Dex and Mid administered at a rate of 0.3 - 4 mg/kg/h; 0.2 - 0.7 μg/kg/h, and 0.02 - 0.1 mg/kg/h, respectively. Results: On the 6th post-treatment day, concentrations of IL-6, IL-1β, and IL-8 in Pro, Dex and Mid groups were 44.82 ± 25.32, 29.84 ± 26.23, and 43.45 ± 24.57 pg/mL; 12.78 ± 4.48, 9.62 ± 2.28, and 12.19 ± 5.20 pg/mL, and 9.57 ± 3.29, 7.38 ± 2.46, and 10.41 ± 3.66 pg/mL, respectively. The Dex group exhibited significantly lower levels than the pre-treatment levels when compared to others (p < 0.05). Conclusion: In patients with AECOPD complicated by sepsis, dexmedetomidine sedation effectively mitigates inflammatory response, enhances immune function, improves oxygenation index, enhances lung static compliance, and decreases hospitalization time. Future studies will require a larger sample size drawn from multiracial populations to validate the findings of this report.