Survey of sedation practices during noninvasive positive-pressure ventilation to treat acute respiratory failure.
OBJECTIVE
Noninvasive positive-pressure ventilation (NPPV) is increasingly used in patients with acute respiratory failure, but few data exist regarding current sedation practices during NPPV. We sought to characterize current practices and attitudes regarding sedation during NPPV.


METHODS
Cross-sectional Web-based survey.


METHODS
Medical institutions.


METHODS
Physician members of the American College of Chest Physician's Critical Care Network (n = 2,656) and the European Respiratory Society's Assembly of Critical Care (n = 339).


METHODS
Survey.


RESULTS
Of the 790 of 2,985 (27%) of physicians who responded, 15%, 6%, and 28% never used sedation, analgesia, or hand restraints any of the time for NPPV patients, respectively, and the large majority reported using these interventions in < or =25% of patients. Sedation, analgesia, and hand restraints were more commonly used by North Americans than Europeans (41% vs. 24% for sedation, 48% vs. 35% for analgesia, and 27% vs. 16% for hand restraints, all p < .01) and critical care vs. noncritical care physicians (42% vs. 24% for sedation and 50% vs. 34% for analgesia, all p < .01). A benzodiazepine alone was the most preferred (33%), followed by an opioid alone (29%). Europeans were less likely to use a benzodiazepine alone (25% vs. 39%, p < .001) but more likely to use an opioid alone (37% vs. 26%, p < .009). Sedation was usually administered as an intermittent intravenous bolus, outside of a protocol, and was assessed by nurses using clinical end points rather than a sedation scale.


CONCLUSIONS
Most physicians infrequently use sedation and analgesic therapy for NPPV to treat acute respiratory failure, but practices vary widely within and between specialties and geographic regions.
Devlin
John W
JW
Northeastern University School of Pharmacy, Boston, MA, USA.
Nava
Stefano
S
Fong
Jeffrey J
JJ
Bahhady
Imad
I
Hill
Nicholas S
NS
D016292:Procedural Sedation; D003430:Cross-Sectional Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D011175:Positive-Pressure Respiration; D010818:Practice Patterns, Physicians'; D045169:Severe Acute Respiratory Syndrome / Q000628:therapy*; D011795:Surveys and Questionnaires