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已发表论文
艾司氯胺酮联合右美托咪定对重症肺炎患者床旁纤维支气管镜吸痰术后即刻氧合指数的影响：一项前瞻性随机对照试验
Authors Wang Y, Zhang R, Wu B, Han J, Li Y, Zhang L
Received 5 August 2025
Accepted for publication 21 November 2025
Published 4 December 2025 Volume 2025:19 Pages 10751—10764
DOI https://doi.org/10.2147/DDDT.S558206
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Leonidas Panos
Yongbin Wang,1 Rumeng Zhang,2 Bo Wu,2 Jueming Han,1 Yuzhen Li,1 Lu Zhang3
1Department of Respiratory and Critical Care Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China; 2Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China; 3Department of Intensive Care Unit, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
Correspondence: Lu Zhang, Department of Intensive Care Unit, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Bei Yuan Street, Jinan, 250033, People’s Republic of China, Tel +0086-17660081006, Email sdeyzl@126.com
Purpose: The aim was to investigate the effect of esketamine-dexmedetomidine (ESK-DEX) combination on immediate postprocedural oxygenation index (OI) in severe pneumonia patients undergoing bedside fiberoptic bronchoscopic (FOB) sputum aspiration, and provide clinical reference.
Methods: A total of 90 patients diagnosed with severe pneumonia receiving non-invasive mechanical ventilation (NIV) who underwent bedside FOB were randomly and evenly divided into three groups: Group C (local anesthesia alone), Group D (DEX alone), Group ED (ESK-DEX). The primary outcome was the OI immediately after procedure (T1). The secondary outcomes: the OI was calculated at 6 h (T2), 12 h (T3), and 24 h (T4) after procedure; the mean arterial pressure (MAP) and heart rate (HR) were assessed at the following time points: FOB tip passage through nostril (t1), glottis (t2), 5 minutes after procedure (t3), and upon procedure completion (t4); Additionally, perioperative adverse events were also documented.
Results: The Group ED demonstrated significantly higher OI compared to Group C at T1 (mean difference, − 8.1; 95% CI, − 13.48, − 2.64; P=0.001). Similarly, the Group ED demonstrated significantly higher OI compared to Group C at each time point from T2 to T4, respectively (all P< 0.05). Regarding hemodynamic parameters, both Group ED and Group D exhibited significantly lower MAP and HR values compared to Group C from t1 to t4 time points, respectively (all P< 0.05). The total incidence of adverse events in Group ED was significantly reduced compared to Groups C (P=0.033).
Conclusion: Compared with conventional sedation protocols, the ESK-DEX combined regimen demonstrated superior OI preservation immediately after procedure, enhanced OI within 24 hours postoperatively, improved hemodynamic stability, and enhanced safety profile in severe pneumonia patients undergoing bedside FOB-guided suction therapy. This pharmacodynamic synergy addresses critical gaps in FOB sedation—simultaneously preventing hypoxemia, maintaining respiratory drive, and minimizing adverse events.
Keywords: esketamine, dexmedetomidine, oxygenation index, fiberoptic bronchoscopy, sputum aspiration
1Department of Respiratory and Critical Care Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China; 2Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China; 3Department of Intensive Care Unit, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
Correspondence: Lu Zhang, Department of Intensive Care Unit, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Bei Yuan Street, Jinan, 250033, People’s Republic of China, Tel +0086-17660081006, Email sdeyzl@126.com
Purpose: The aim was to investigate the effect of esketamine-dexmedetomidine (ESK-DEX) combination on immediate postprocedural oxygenation index (OI) in severe pneumonia patients undergoing bedside fiberoptic bronchoscopic (FOB) sputum aspiration, and provide clinical reference.
Methods: A total of 90 patients diagnosed with severe pneumonia receiving non-invasive mechanical ventilation (NIV) who underwent bedside FOB were randomly and evenly divided into three groups: Group C (local anesthesia alone), Group D (DEX alone), Group ED (ESK-DEX). The primary outcome was the OI immediately after procedure (T1). The secondary outcomes: the OI was calculated at 6 h (T2), 12 h (T3), and 24 h (T4) after procedure; the mean arterial pressure (MAP) and heart rate (HR) were assessed at the following time points: FOB tip passage through nostril (t1), glottis (t2), 5 minutes after procedure (t3), and upon procedure completion (t4); Additionally, perioperative adverse events were also documented.
Results: The Group ED demonstrated significantly higher OI compared to Group C at T1 (mean difference, − 8.1; 95% CI, − 13.48, − 2.64; P=0.001). Similarly, the Group ED demonstrated significantly higher OI compared to Group C at each time point from T2 to T4, respectively (all P< 0.05). Regarding hemodynamic parameters, both Group ED and Group D exhibited significantly lower MAP and HR values compared to Group C from t1 to t4 time points, respectively (all P< 0.05). The total incidence of adverse events in Group ED was significantly reduced compared to Groups C (P=0.033).
Conclusion: Compared with conventional sedation protocols, the ESK-DEX combined regimen demonstrated superior OI preservation immediately after procedure, enhanced OI within 24 hours postoperatively, improved hemodynamic stability, and enhanced safety profile in severe pneumonia patients undergoing bedside FOB-guided suction therapy. This pharmacodynamic synergy addresses critical gaps in FOB sedation—simultaneously preventing hypoxemia, maintaining respiratory drive, and minimizing adverse events.
Keywords: esketamine, dexmedetomidine, oxygenation index, fiberoptic bronchoscopy, sputum aspiration