Cipepofol versus Conventional Sedation for Pneumonia Patients Receiving Mechanical Ventilation: A Real-World Retrospective Study of Effectiveness and Hemodynamic Safety.
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Abstract
Purpose: Severe pneumonia often necessitates invasive mechanical ventilation (MV) and prolonged sedation in the ICU. This real-world retrospective cohort study aimed to compare cipepofol vs conventional sedation regimens in this vulnerable population, with MV duration as the primary endpoint and hemodynamic safety as a key safety outcome.
Patients and methods: This retrospective cohort study evaluated mechanically ventilated patients with severe pneumonia who received continuous sedation for more than 48 hours. Patients were classified into cipepofol or conventional sedation (propofol-, midazolam- or dexmedetomidine-based) groups. Propensity score matching (PSM) was performed at a 1:1 ratio based on age and APACHE II scores.
Results: After PSM, 198 patients (99 per group) were analyzed. The primary endpoint-MV duration did not differ significantly between the cipepofol and conventional groups (median 218.23 vs 227.25 hours, P = 0.740). Subgroup analysis further confirmed that there was no significant difference in MV duration between propofol- and midazolam-based regimens compared to the cipepofol-regimen. Notably, cipepofol demonstrated superior hemodynamic safety, showing significantly lower incidences of early hypotension within the first hour (11.1% vs 27.3%, P=0.007) and overall bradycardia (19.1% vs 36.1%, P=0.014). Post-hoc subgroups analysis revealed that cipepofol reduced the risks of early hypotension and overall bradycardia compared to propofol- or midazolam-based regimens in hospital-acquired pneumonia patients. Multivariate analysis confirmed cipepofol use as an independent protective factor against early hypotension (adjusted OR 0.300, 95% CI: 0.136-0.665, P=0.003) and bradycardia (adjusted OR 0.414, 95% CI: 0.212-0.808, P=0.010). No significant differences were found regarding sedation success, length of ICU stay, 28-day ventilator-free days, 28-day mortality, vasopressor requirements, or organ function parameters (all P>0.05).
Conclusion: In mechanically ventilated patients with severe pneumonia requiring prolonged sedation, cipepofol did not shorten MV duration compared with propofol- or midazolam-based conventional regimens, but it significantly reduced risks for early hypotension and overall bradycardia events.
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Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications.
The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas.
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