Sedation for Noninvasive Ventilation in Intensive Care
At the end of the first decade of the 21st century, noninvasive ventilation (NIV) is increasingly being used to manage patients with acute respiratory failure (ARF). Notwithstanding the advantages of NIV in critically ill patients, NIV is associated with a high risk of failures, including patient refusal to continue the often-uncomfortable sessions. Compared with those who avoid intubation, patients who fail NIV have worse outcomes, including death, so maintenance of patient comfort to optimize the chances of success during NIV is an important goal of therapy. Since the description of ARF and its treatment with NIV and sedation with morphine and midazolam by Rocker et al. , the conventional approach to ventilation has been to use tracheal intubation in cases of low tolerance. Some authors have proposed the use of sedation to increase patient comfort and NIV tolerance. In a world survey on sedation for NIV , the physicians who responded reported using sedation or analgesia in less than 25% of patients. Current sedation practices were heterogeneous and mainly determined by clinical experience. These observations emphasize the lack of evidence-based information or recommendations for the use of sedation during NIV. Notwithstanding, if sedation could decrease NIV failure, it should be used with caution by a trained team with some recommendations.
KeywordsIntensive Care Unit Acute Respiratory Failure Pressure Support Ventilation Continuous Administration Noninvasive Ventilation