Next-day residual effects of hypnotics in DSM-IV primary insomnia: a driving simulator study with simultaneous electroencephalogram monitoring

Rationale Most studies that investigated the next-day residual effects of hypnotic drugs on daytime driving performances were performed on healthy subjects and after a single drug administration. Objectives In the present study, we further examine whether the results of these studies could be generalised to insomniac patients and after repeated drug administration. Method Single and repeated (7 day) doses of zolpidem (10 mg), zopiclone (7.5 mg), lormetazepam (1 mg) or placebo were administered at bedtime in a crossover design to 23 patients (9 men and 14 women aged 38.8±2.0 years) with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) primary insomnia. Driving tests were performed 9–11 h post-dose. Results Results showed that treatment effects were evidenced for subjective sleep, for driving abilities, and for electroencephalogram (EEG) recorded before (resting EEG) and during the driving simulation test (driving EEG). Compared to placebo, zopiclone increased the number of collisions and lormetazepam increased deviation from speed limit and deviation from absolute speed, whereas zolpidem did not differentiate from placebo on these analyses. EEG recordings showed that in contrast to zolpidem, lormetazepam and zopiclone induced typical benzodiazepine-like alterations, suggesting that next-day poor driving performance could relate to a prolonged central nervous system effect of these two hypnotics. Conclusion The present results corroborate studies on healthy volunteers showing that residual effects of hypnotics increase with their half-lives. The results further suggest that drugs preserving physiological EEG rhythms before and during the driving simulation test 9–11 h post-dose, such as zolpidem, do not influence next-day driving abilities.     

The effect of driving pressures in COVID-19 ARDS: Lower may still be better as in classic ARDS

BackgroundThe respiratory dynamics of coronavirus disease 2019 (COVID-19) patients under invasive ventilation are still not well known. In this prospective cohort, we aimed to assess the characteristics of the respiratory system in COVID-19 patients under invasive mechanical ventilation and evaluate their relationship with mortality.MethodsFifty-eight COVID-19 patients who underwent invasive mechanical ventilation between March 11, 2020 and September 1, 2020 were enrolled for the present study. Demographics and laboratory values at baseline were recorded. Respiratory variables such as tidal volume, plateau pressure, positive end expiratory pressure, static compliance, and driving pressure were recorded daily under passive conditions. Further, the median values were analyzed.ResultsMedian age of the patients was 64 years (58–72). Mortality was 60% on day 28. Plateau pressure, driving pressure, and static compliance significantly differ between the survivors and non-survivors. When patients were categorized into two groups based on the median driving pressure (Pdrive) of ≤15 cmH₂O or >15 cmH₂O during their invasive mechanical ventilation period, there was significantly better survival on day 28 in patients having a Pdrive ≤ 15 cmH₂O [28 days (95% CI = 19–28) vs 16 days (95% CI = 6–25), (log-rank p = 0.026).ConclusionCOVID-19 related acute respiratory distress syndrome (ARDS) seemed to have similar characteristics as other forms of ARDS. Lung protective ventilation with low plateau and driving pressures might be related to lower mortality.     

Nystagmus among suspected amphetamine impaired drivers

Clinical signs of drug use can be helpful to identify which drug has been consumed. Amphetamine intake has traditionally not been considered to cause nystagmus. The aim of this study was to explore whether there is a relationship between amphetamine use and nystagmus in a population of apprehended drivers in a naturalistic setting. We evaluated drivers suspected of drug-impaired driving where blood samples were collected and a clinical test of impairment (CTI) was performed. Evaluation of nystagmus is one of the CTI subtests. The samples were analysed for alcohol and psychoactive drugs. Cases with a nystagmus test were recorded and amphetamine-only cases were compared with alcohol-only cases and with cases where alcohol or drugs were not detected, respectively. Samples from 507 amphetamine-only cases were compared to 485 alcohol-only cases and 205 drug-negative cases. The median blood amphetamine concentration was 0.37 mg/L and the median alcohol concentration was 1.57 g/kg. The proportion of cases with nystagmus was similar in amphetamine-only cases (21%) and drug-negative controls (25%), p = 0.273, but higher in alcohol-only cases (53%), p < 0.001. No association was found between the blood amphetamine concentration and degree of nystagmus (Spearman's ρ = 0.008, p = 0.860), whereas an association between blood alcohol concentration and degree of nystagmus was demonstrated (ρ = 0.249, p < 0.001). In conclusion, our study did not find that apprehended drivers using amphetamine had more frequently nystagmus than a control group that tested negative for alcohol and drugs, even at high amphetamine concentrations in blood. Hence, nystagmus should not be considered a tool for identifying amphetamine-induced impairment in drivers.     

驱动压导向呼气末正压个体化滴定对老年患者腹腔镜结直肠癌根治术后肺不张的影响

目的 探讨基于肺超声评分(LUS)评估驱动压导向呼气末正压(PEEP)个体化滴定对老年患者腹腔镜结直肠癌根治术后肺不张的影响。方法 选择2021年11月至2022年5月择期行腹腔镜结直肠癌根治术患者60例，男39例，女21例，年龄≥65岁，BMI<30 kg/m²,ASAⅡ或Ⅲ级。采用随机数字表法将患者分为三组：驱动压A组(A组)、驱动压B组(B组)和对照组(C组),每组20例。A组和B组在完成气管插管后通过滴定PEEP寻找驱动压最低值，与驱动压最低值相应的PEEP值为最优PEEP值。A组术中进行动态PEEP优化，每隔1 h或进行与肺塌陷有关的操作后均重复PEEP滴定；B组选择最优PEEP完成机械通气；C组以5 cm H₂O的固定PEEP完成机械通气。记录麻醉诱导前(T₀)、手术结束气管导管拔除前(T₅)和气管导管拔除后30 min(T₆)的LUS和肺不张发生情况。记录平卧位最优PEEP设置完成后5 min(T₁)、气腹后30 min(T_2...