Use of dexmedetomidine to facilitate non-invasive ventilation

DeMuro, Jonas P.; Mongelli, Michael N.; Hanna, Adel

doi:10.4103/2229-5151.124161

Cited by 12 publications

(9 citation statements)

References 7 publications

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“…Patients did not usually receive sedatives. If they were agitated and uncomfortable with the mask, intravenous morphine or dexmedetomidine was initiated [ 17 ]. All patients were monitored with continuous electrocardiography and SpO 2 .…”

Section: Methodsmentioning

confidence: 99%

Performance of noninvasive ventilation in acute respiratory failure in critically ill patients: a prospective, observational, cohort study

et al. 2015

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BackgroundNoninvasive ventilation (NIV) is used in critically ill patients with acute respiratory failure (ARF) to avoid endotracheal intubation. However, the impact of NIV use on ARF patient’s outcomes is still unclear. Our objectives were to evaluate the rate of NIV failure in hypoxemic patients with an arterial carbon dioxide partial pressure (PaCO2) < 45 mmHg or ≥ 45 mmHg at ICU admission, the predictors of NIV failure, ICU and hospital length of stay and 28-day mortality.MethodsProspective single center cohort study. All consecutive patients admitted to a mixed ICU during a three-month period who received NIV, except for palliative care purposes, were included in this study. Demographic data, APACHE II score, cause of ARF, number of patients that received NIV, incidence of NIV failure, length of ICU, hospital stay and mortality rate were compared between NIV failure and success groups.ResultsEighty-five from 462 patients (18.4 %) received NIV and 26/85 (30.6 %) required invasive mechanical ventilation. NIV failure patients were comparatively younger (67 ± 21 vs. 77 ± 14 years; p = 0.031), had lower arterial bicarbonate (p = 0.005), lower PaCO2 levels (p = 0.032), higher arterial lactate levels (p = 0.046) and APACHE II score (p = 0.034) compared to NIV success patients. NIV failure occurred in 25.0 % of patients with PaCO2 ≥ 45 mmHg and in 33.3 % of patients with PaCO2 < 45 mmHg (p = 0.435). NIV failure was associated with an increased risk of in-hospital death (OR 4.64, 95 % CI 1.52 to 14.18; p = 0.007) and length [median (IQR)] of ICU [12 days (8–31) vs. 2 days (1–4); p < 0.001] and hospital [30 (19–42) vs. 15 (9–33) days; p = 0.010] stay. Predictors of NIV failure included age (OR 0.96, 95 % CI 0.93 to 0.99; p = 0.007) and APACHE II score (OR 1.13, 95 % CI 1.02 to 1.25; p = 0.018).ConclusionNIV failure was associated with an increased risk of in-hospital death, ICU and hospital stay and was not affected by baseline PaCO2 levels. Patients that failed were comparatively younger and had higher APACHE II score, suggesting the need for a careful selection of patients that might benefit from NIV. A well-designed study on the impact of a short monitored NIV trial on outcomes is needed.

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Section: Methodsmentioning

confidence: 99%

Performance of noninvasive ventilation in acute respiratory failure in critically ill patients: a prospective, observational, cohort study

et al. 2015

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“…A case report of a 91-year-old man with COPD on non-invasive ventilation states that dexmedetomidine facilitated non-invasive ventilation and reduced the hospital stay. 17 A phase II study by Venn et al 18 concluded that the use of dexmedetomidine to perform rescue intubation in patients reduced the propofol dose, as well as causing a slight decrease in blood pressure, heart rate, and heart output volume, and did not cause any complications after discontinuation. Although the design of this study was not similar to ours, a reduction in blood pressure in patients receiving dexmedetomidine was seen in our study as well; however, we did not observe any effect on patients' heart rate.…”

Section: Discussionmentioning

confidence: 99%

“…A case report of a 91-year-old man with COPD on non-invasive ventilation states that dexmedetomidine facilitated non-invasive ventilation and reduced the hospital stay [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine as an adjunctive treatment for acute asthma

et al. 2021

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Objective This study aimed to compare the efficacy of using dexmedetomidine with salbutamol and salbutamol nebulization alone in patients with acute exacerbation of asthma presenting to the emergency department.Methods This clinical trial included 60 patients, in the age range of 18 to 55 years, with signs of bronchospasm presenting to the emergency department. In the intervention group, dexmedetomidine 0.5 µg/kg was injected intravenously and three doses of salbutamol nebulization were administered over 60 minutes. In the control group, salbutamol nebulization was administered for 60 minutes three times. The patient's clinical status, based on clinical symptoms, consciousness, speech, breathing rate, heart rate, and blood pressure were recorded before the intervention, and peak expiratory flow rate and forced expiratory volume in 1 second were measured at 20, 40, and 60 minutes after intervention. Patients who did not respond to the intervention were excluded from the study within 60 minutes. ResultsThe increased mean forced expiratory volume in 1 second and mean peak expiratory flow rate were found to be similar in both groups during the treatment (P = 0.304). The mean systolic and diastolic blood pressure recorded at 40 and 60 minutes were significantly lower in the intervention group. During this study, no patient was excluded before 60 minutes. ConclusionAdministration of dexmedetomidine in addition to standard salbutamol treatment has no beneficial effect in patients with acute asthma attacks and merely causes hypotension in patients.

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“…NIV is useful for many cases, but only a few patients could tolerate this procedure due to the discomfort of using this type of ventilation. Therefore, some studies found that using sedation during NIV technique should be considered to reduce the percentage of NIV failure and comfort the patient during NIV (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) . Some studies reported that NIV was challenging to apply in the Intensive Care Unit (ICU) because of patient agitation (4)(5)(6) .…”

Section: Introductionmentioning

confidence: 99%

Sedation During Non-invasive Ventilation and its Association with Intubation Rate and Intensive Care Units Stay among Adult Patients at King Abdulaziz Medical City

2020

IJPHRD

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Background: Non-invasive ventilation (NIV) is a procedure of providing the patient, positive pressure ventilation without the use of artificial airway. Some patients may require minimum sedation for patient comfort. However, there are few studies examined the effect of using sedation with NIV. This study aimed to examine the prevalence of using sedation during NIV. Methods:A cross-sectional study was carried out at King Abdulaziz Medical City (KAMC) from 2016-2018 using data from an electronic medical record of patients who received NIV in ICUs. We collected demographic data, type of NIV, comorbidity, and type of sedation. We studied the outcome of intubation rate, length of ICUs stays and mortality for patients who received sedation during NIV.Results: Total of 110 adult patients were included in this study, with a median age of 70 years (IQR 63-78 years), and 53% were female patients. Most patients had COPD as a cause of ICU admission (31%). Among this population, only six patients, 5.45% received sedation during NIV in which the majority received Dexmedetomidine. Intubation rate was 12% among all patients, 33% of them received sedation. The median of the length of stay for the sedated patient was 7.5 .Conclusions: Using sedation during NIV is not a common practice for patients admitted in ICU. Using sedation during NIV did not have a significant effect on reducing intubation rate or ICU stay.

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Use of dexmedetomidine to facilitate non-invasive ventilation

Cited by 12 publications

References 7 publications

Performance of noninvasive ventilation in acute respiratory failure in critically ill patients: a prospective, observational, cohort study

Performance of noninvasive ventilation in acute respiratory failure in critically ill patients: a prospective, observational, cohort study

Dexmedetomidine as an adjunctive treatment for acute asthma

Sedation During Non-invasive Ventilation and its Association with Intubation Rate and Intensive Care Units Stay among Adult Patients at King Abdulaziz Medical City

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