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Effects of Esketamine-Dexmedetomidine Combination on Immediate Postprocedural Oxygenation Index in Severe Pneumonia Patients Undergoing Bedside Fiberoptic Bronchoscopic Sputum Aspiration: A Prospective Randomised Controlled Trial

Year: 2025

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: 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

Source: Drug Design Development and Therapy

DOI: 10.2147/dddt.s558206

Authors: Yongbin Wang, Rumeng Zhang, Bo Wu, Jueming Han, Yuzhen Li, Lu Zhang

Institutions: Shandong University, Second Hospital of Shandong University

Language: English

Topic: Anesthesia and Sedative Agents

Subfield: Anesthesiology and Pain Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,836