Remifentanil-based sedation to treat noninvasive ventilation failure: a preliminary study.
OBJECTIVE
To assess the feasibility and safety of remifentanil-based sedation during noninvasive ventilation (NIV) in patients with NIV failure.


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


METHODS
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.


METHODS
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.


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 microg/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 1h. 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.


CONCLUSIONS
This pilot study shows that remifentanil-based sedation is safe and effective in the treatment of NIV failure due to low tolerance.
Constantin
Jean-Michel
JM
CHU Clermont-Ferrand, Service de Reanimation Adulte, Hôtel-Dieu Hospital, 63058, Clermont-Ferrand, France. jmconstantin@chu-clermontferrand.fr
Schneider
Eric
E
Cayot-Constantin
Sophie
S
Guerin
Renaud
R
Bannier
Francois
F
Futier
Emmanuel
E
Bazin
Jean-Etienne
JE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000627:therapeutic use*; D011446:Prospective Studies; D000077208:Remifentanil; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy*; D017211:Treatment Failure
D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil