Utilization of pain and sedation therapy on noninvasive mechanical ventilation in Korean intensive care units: a multi-center prospective observational study

Abstract

Background The use of sedative drugs may be an important therapeutic intervention during noninvasive ventilation (NIV) in intensive care units (ICUs). The purpose of this study was to assess the current application of analgosedation in NIV and its impact on clinical outcomes in Korean ICUs. Methods Twenty Korean ICUs participated in the study, and data was collected on NIV use during the period between June 2017 and February 2018. Demographic data from all adult patients, NIV clinical parameters, and hospital mortality were included. Results A total of 155 patients treated with NIV in the ICUs were included, of whom 26 received pain and sedation therapy (sedation group) and 129 did not (control group). The primary cause of ICU admission was due to acute exacerbation of obstructed lung disease (45.7%) in the control group and pneumonia treatment (53.8%) in the sedation group. In addition, causes of NIV application included acute hypercapnic respiratory failure in the control group (62.8%) and post-extubation respiratory failure in the sedation group (57.7%). Arterial partial pressure of carbon dioxide (PaCO 2 ) levels before and after 2 hours of NIV treatment were significantly decreased in both groups: from 61.9±23.8 mm Hg to 54.9±17.6 mm Hg in the control group (P<0.001) and from 54.9±15.1 mm Hg to 51.1±15.1 mm Hg in the sedation group (P=0.048). No significant differences were observed in the success rate of NIV weaning, complications, length of ICU stay, ICU survival rate, or hospital survival rate between the groups. Conclusions In NIV patients, analgosedation therapy may have no harmful effects on complications, NIV weaning success, and mortality compared to the control group. Therefore, sedation during NIV may not be unsafe and can be used in patients for pain control when indicated.

Comfort During Non-invasive Ventilation

“…In this regard, NIV failure, defined as the need for endotracheal intubation, is the main issue while dealing with patients with NIV ( 14 ). Surprisingly, NIV is still burdened with a high failure rate (up to 40%) today, due, in most cases, to patient discomfort or rejection ( 15 – 17 ). During NIV, comfort is intended as the complex dynamic state based on the acceptance of non-invasive respiratory assistance in the absence of pain and emotional/physical distress ( 18 ).…”

2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit

“…The implementation of assessment-driven and standardized pain management is vital due to the characteristics of critically ill patients, such as communication disorders, altered mental status, mechanical ventilation, invasive procedure and devices, and immobility. Compared to conventional treatment, protocol-based pain control and sedation may reduce nosocomial infections, hypotension, bradycardia, the use of sedatives without increased narcotic analgesics, the duration of mechanical ventilation, ICU LOS, and severity of pain [ 2 , 3 ]. Thus, it is recommended to regularly conduct a protocol-driven pain assessment using validated tools and provide a definite guideline for medication selection and dosage.…”

Dexmedetomidine-Induced Aortic Contraction Involves Transactivation of the Epidermal Growth Factor Receptor in Rats

“…The alpha-2 adrenoceptor agonist dexmedetomidine is used as a sedative in operating rooms and intensive care units [1,2]. The intravenous administration of a large dose of dexmedetomidine (1 or 2 µg/kg) produces a biphasic response, characterized by a transient increase and then a decrease in blood pressure [3].…”