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Therefore, we conducted a randomized controlled trial comparing the effects of esketamine\/midazolam and remifentanil\/midazolam on respiratory mechanics and oxygenation in mechanically ventilated patients with ARDS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>In this prospective, randomized, controlled study, patients with ARDS who were undergoing mechanical ventilation were randomly assigned to receive either remifentanil\/midazolam (<jats:italic>n<\/jats:italic>\u2009=\u200925) or esketamine\/midazolam (<jats:italic>n<\/jats:italic>\u2009=\u200925). Both groups maintained equivalent levels of sedation and analgesia. The primary outcomes were airway resistance (R<jats:sub>aw<\/jats:sub>) and static respiratory system compliance (C<jats:sub>st<\/jats:sub>) at 24, 48, and 72\u00a0h post-medication administration. Plateau Pressure (P<jats:sub>plat<\/jats:sub>), peak airway pressure (P<jats:sub>peak<\/jats:sub>), hemodynamic parameters, mechanical ventilation duration, and ICU length of stay were also recorded.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>C<jats:sub>st<\/jats:sub> at 72\u00a0h post-medication in esketamine group (49.8\u2009\u00b1\u200913.8) was higher than that in control group (42.4\u2009\u00b1\u200911.9) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). There was no significant difference in R<jats:sub>aw<\/jats:sub> at 24\u00a0h, 48\u00a0h and 72\u00a0h post-medication between the two groups (<jats:italic>P<\/jats:italic>\u2009&gt;\u20090.05). At 72\u00a0h post-medication, both P<jats:sub>plat<\/jats:sub> and P<jats:sub>peak<\/jats:sub> in the esketamine group [(15.6\u2009\u00b1\u20093.1); (25.7\u2009\u00b1\u20093.8)] were significantly lower than those in the control group[(17.7\u2009\u00b1\u20094.2); (28.5\u2009\u00b1\u20094.7)] (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). Additionally, the esketamine group [(256.6\u2009\u00b1\u200989.1); (266.4\u2009\u00b1\u200988.4); (284.92\u2009\u00b1\u200984.45)] demonstrated significantly higher PaO\u2082\/FiO\u2082 ratios compared to the control group [(208.7\u2009\u00b1\u200961.5);(219.52\u2009\u00b1\u200961.28); (222.00\u2009\u00b1\u200968.54)] at all measured time points (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). MAP and heart rate were higher in the esketamine group than in the control group, while cumulative doses of vasoactive drugs were comparatively lower in the esketamine group. The duration of mechanical ventilation and ICU length of stay did not-differ (<jats:italic>P<\/jats:italic>\u2009&gt;\u20090.05).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Esketamine\/midazolam leads to improved in C<jats:sub>st<\/jats:sub> and PaO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> ratio compared to remifentanil\/midazolam in mechanically ventilated patients with ARDS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical trial registration<\/jats:title>\n            <jats:p>This study was registered at Chinese Clinical Trial Registry (ChiCTR2300070733) on April 21, 2023. URL: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.chictr.org.cn\/\" ext-link-type=\"uri\">https:\/\/www.chictr.org.cn\/<\/jats:ext-link>.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12871-025-03211-x","type":"journal-article","created":{"date-parts":[[2025,7,5]],"date-time":"2025-07-05T11:07:04Z","timestamp":1751713624000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Comparison of the effects of esketamine\/midazolam and remifentanil\/midazolam on respiratory mechanics in mechanically ventilated patients with acute respiratory distress syndrome"],"prefix":"10.1186","volume":"25","author":[{"given":"Dujuan","family":"Qiao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huanjia","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingzhi","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junkai","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linong","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,5]]},"reference":[{"issue":"8","key":"3211_CR1","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1001\/jama.2016.0291","volume":"315","author":"G Bellani","year":"2016","unstructured":"Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, Gattinoni L, van Haren F, Larsson A, McAuley DF, et al. 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