Remifentanil-based sedation to treat noninvasive ventilation failure: a preliminary study

Abstract

This pilot study shows that remifentanil-based sedation is safe and effective in the treatment of NIV failure due to low tolerance.

Sedation during noninvasive mechanical ventilation

“…Bazı araştırmacılar sedasyon kullanımının NIMV toleransını ve hasta konforunu artırdığını öne sürmektedir. Yapılan pilot çalışmalarda NIMV sırasında bir tek sedatif ve analjezik ajanın sürekli infüzyonunun titre edilerek "bilinçli sedasyonuyanık sedasyon" sağlanmasının, solunum dürtüsü, solunum paterni ve hemodinamik parametreler üze-rinde belirgin değişiklikler yapmadan hasta konforunu artırdığı belirtilmektedir (12,13).…”

Is sedation safe and beneficial in patients receiving NIV? Yes

“…Taken together, the results of these studies are encouraging [7][8][9][10][11][12][13]. Overall, the use of sedation during NIV appears feasible and safe.…”

“…In addition to the present trial [5], several observational studies [7][8][9][10][11] and three randomized trials comparing midazolam and dexmedetomidine or placebo [12][13][14] have assessed the potential use of sedative and/or analgesic drugs to reduce discomfort and risk of NIV failure. The main characteristics and results of these studies are Table 1.…”

“…Whatever the drugs used, the goal was to achieve a level of sedation to a point where patients were awake, arousable, and comfortable. Pilot studies have suggested that continuous infusion of a single sedative agent may decrease patient discomfort, with no significant deleterious effects on respiratory drive, respiratory pattern or hemodynamics, and with improvement in gas exchanges [7][8][9][10][11].…”

“…Overall, the use of sedation during NIV appears feasible and safe. The ''curative'' use of sedation-analgesia, i.e., applied for treating discomfort leading to NIV intolerance, seems to be able to avoid intubation in 55-70 % of cases [8][9][10][11][12][13], while ensuring the desired level of awake sedation. By contrast, the ''preventive'' administration of sedation-analgesia, i.e., at initiation of NIV to prevent discomfort leading to intolerance, has so far not shown encouraging results [14].…”