title: Target-controlled infusion of propofol for sedation in patients with non-invasive ventilation failure due to low tolerance: a preliminary study.
abstract: OBJECTIVE
  Non-invasive ventilation (NIV) in critically ill patients is associated with a high failure rate. This prospective study assessed the feasibility and safety of target-controlled infusion (TCI) of propofol for conscious sedation during NIV in patients with NIV failure due to low tolerance.
  
  
  METHODS
  Ten patients with NIV failure due to discomfort, agitation and/or refusal to continue with this ventilatory support were included; seven had acute respiratory failure and three had acute hypercapnic respiratory failure. Patients were sedated by TCI of propofol during NIV sessions. Blood gas analysis, cardiorespiratory and ventilatory parameters, propofol concentration (Cpt) required, comfort and adverse events were recorded.
  
  
  RESULTS
  Patients received a total of 85 NIV sessions, totalling 180 h of NIV under TCI of propofol (mean Cpt, 0.82 ± 0.25 μg/ml). NIV under TCI of propofol significantly improved arterial blood gas analyses: mean Pa/FiO(2) ratio increased from 167 ± 68 pre-session to 195 ± 68 post-session (p < 0.05), mean PaCO(2) decreased from 57.8 ± 15.3 to 49 ± 9.8 mmHg (p < 0.05) and mean pH increased from 7.36 ± 0.04 to 7.4 ± 0.03 (p < 0.05). Three patients required endotracheal intubation, two due to evolution of underlying disease and one because of a seizure disorder. Eight patients were discharged from the intensive care unit and two died.
  
  
  CONCLUSIONS
  This preliminary study shows that in a selected population, TCI of propofol can facilitate acceptance of NIV. Within the limits of a pilot study, TCI of propofol seems to be safe and effective for the treatment of NIV failure due to low tolerance.
authors.affiliation: Medical Intensive Care Unit, Pellegrin Teaching Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France. benjamin.clouzeau@chu-bordeaux.fr.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Clouzeau
authors.affiliation: Medical Intensive Care Unit, Pellegrin Teaching Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France.
authors.forename: Hoang-Nam
authors.initials: HN
authors.lastname: Bui
authors.affiliation: Medical Intensive Care Unit, Pellegrin Teaching Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Vargas
authors.affiliation: Medical Intensive Care Unit, Pellegrin Teaching Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France.
authors.forename: Marieke
authors.initials: M
authors.lastname: Grenouillet-Delacre
authors.affiliation: Medical Intensive Care Unit, Pellegrin Teaching Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Guilhon
authors.affiliation: Medical Intensive Care Unit, Pellegrin Teaching Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Gruson
authors.affiliation: Medical Intensive Care Unit, Pellegrin Teaching Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Hilbert
mesh_terms: D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D012123:Pulmonary Ventilation
chemical_list: D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D015742:Propofol
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