Remifentanil-based sedation to treat noninvasive ventilation failure: a preliminary study
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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.
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.
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.
This pilot study shows that remifentanil-based sedation is safe and effective in the treatment of NIV failure due to low tolerance.
KeywordsNoninvasive ventilation Acute respiratory failure Mechanical ventilation Remifentanil Critical care Sedation
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