Intensive Care Medicine

, Volume 33, Issue 1, pp 82–87

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

  • Jean-Michel Constantin
  • Eric Schneider
  • Sophie Cayot-Constantin
  • Renaud Guerin
  • Francois Bannier
  • Emmanuel Futier
  • Jean-Etienne Bazin
Original

DOI: 10.1007/s00134-006-0447-4

Cite this article as:
Constantin, J., Schneider, E., Cayot-Constantin, S. et al. Intensive Care Med (2007) 33: 82. doi:10.1007/s00134-006-0447-4

Abstract

Objective

To assess the feasibility and safety of remifentanil-based sedation during noninvasive ventilation (NIV) in patients with NIV failure.

Design and setting

Prospective clinical investigation in a 16-bed intensive care unit of a university hospital in France.

Patients

Thirteen patients in NIV failure due to discomfort and/or refusal to continue this ventilatory support: 10 with acute respiratory failure and 3 with acute hypercapnic respiratory failure.

Intervention

Patients were administered methylene blue and were sedated (Ramsay scale 2–3) by a continuous perfusion of remifentanil during NIV. Cardiorespiratory and ventilatory parameters, blood gas analysis, and adverse events were prospectively recorded.

Measurements and results

The 13 patients received a total of 125 NIV sessions, totaling 1200 h, of NIV under remifentanil-based sedation (mean remifentanil dose 0.1 ± 0.03 μg/kg per minute). Three patients also required propofol. PaO2/FIO2 ratio increased from 134 ± 69 to 187 ± 43 mmHg after 1 h. In patients with acute respiratory failure respiratory rate decreased from 34 ± 12 per minute before remifentanil to 25 ± 4 per minute after 1 h. In the three patients with acute hypercapnic respiratory failure PaCO2 decreased from 69 ± 7 to 42 ± 5 mmHg. Four patients required endotracheal intubation without aspiration pneumonia. Twelve of the 13 patients left the ICU.

Conclusion

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

Keywords

Noninvasive ventilationAcute respiratory failureMechanical ventilationRemifentanilCritical careSedation

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Jean-Michel Constantin
    • 1
    • 2
  • Eric Schneider
    • 1
  • Sophie Cayot-Constantin
    • 1
  • Renaud Guerin
    • 1
  • Francois Bannier
    • 1
  • Emmanuel Futier
    • 1
  • Jean-Etienne Bazin
    • 1
    • 3
  1. 1.CHU Clermont-Ferrand, Service de Reanimation AdulteHôtel-Dieu HospitalClermont-FerrandFrance
  2. 2.INSERMClermont-FerrandFrance
  3. 3.Univ Clermont 1, Fac MedecineClermont-FerrandFrance