title: Sedation in non-invasive ventilation: do we know what to do (and why)?
abstract: This review examines some of the issues encountered in the use of sedation in patients receiving respiratory support from non-invasive ventilation (NIV). This is an area of critical and intensive care medicine where there are limited (if any) robust data to guide the development of best practice and where local custom appears to exert a strong influence on patterns of care. We examine aspects of sedation for NIV where the current lack of structure may be contributing to missed opportunities to improve standards of care and examine the existing sedative armamentarium. No single sedative agent is currently available that fulfils the criteria for an ideal agent but we offer some observations on the relative merits of different agents as they relate to considerations such as effects on respiratory drive and timing, and airways patency. The significance of agitation and delirium and the affective aspect(s) of dyspnoea are also considered. We outline an agenda for placing the use of sedation in NIV on a more systematic footing, including clearly expressed criteria and conditions for terminating NIV and structural and organizational conditions for prospective multicentre trials.
authors.affiliation: Université Paris-Diderot, Hôpitaux Universitaires Paris Nord Val de Seine, Département d'Anesthésie Réanimation Chirurgicale, Hôpital Bichat-Claude Bernard, Paris, France.
authors.forename: Dan
authors.initials: D
authors.lastname: Longrois
authors.affiliation: Department of Intensive Care and Anesthesiology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conti
authors.affiliation: Anesthesiology Department, Beaujon Hospital, AP-HP, Université Paris-Diderot, Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Mantz
authors.affiliation: First Department of Internal Medicine, Kliniken Nordoberpfalz AG, Klinikum Weiden, Weiden, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Faltlhauser
authors.affiliation: Department of Anesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland.
authors.forename: Riku
authors.initials: R
authors.lastname: Aantaa
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Emergency Medicine Hospital Links der Weser GmbH, Bremen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Tonner
keywords: Agitation; Benzodiazepines; Delirium; Dexmedetomidine; Dyspnoea; Ketamine; Non-invasive ventilation; Opioids; Propofol; Sedation