title: Impact of sedation and analgesia during noninvasive positive pressure ventilation on outcome: a marginal structural model causal analysis.
abstract: OBJECTIVE
  There are limited data available about the role of sedation and analgesia during noninvasive positive pressure ventilation (NPPV). The objective of study was to estimate the effect of analgesic or sedative drugs on the failure of NPPV.
  
  
  METHODS
  We studied patients who received at least 2 h of NPPV as first-line therapy in a prospective observational study carried out in 322 intensive care units from 30 countries. A marginal structural model (MSM) was used to analyze the association between the use of analgesic or sedative drugs and NPPV failure (defined as need for invasive mechanical ventilation).
  
  
  RESULTS
  842 patients were included in the analysis. Of these, 165 patients (19.6%) received analgesic or sedative drugs at some time during NPPV; 33 of them received both. In the adjusted analysis, the use of analgesics (odds ratio 1.8, 95% confidence interval 0.6-5.4) or sedatives (odds ratio 2.8, 95% CI 0.85-9.4) alone was not associated with NPPV failure, but their combined use was associated with failure (odds ratio 5.7, 95% CI 1.8-18.4).
  
  
  CONCLUSIONS
  Slightly less than 20% of patients received analgesic or sedative drugs during NPPV, with no apparent effect on outcome when used alone. However, the simultaneous use of analgesics and sedatives may be associated with failure of NPPV.
authors.affiliation: Unidad de Bioestadística Clínica Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS) and Centro de Investigación en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
authors.forename: Oscar
authors.initials: O
authors.lastname: Peñuelas
authors.forename: Fernando
authors.initials: F
authors.lastname: Frutos-Vivar
authors.forename: Alejandro C
authors.initials: AC
authors.lastname: Arroliga
authors.forename: Victor
authors.initials: V
authors.lastname: Abraira
authors.forename: Arnaud W
authors.initials: AW
authors.lastname: Thille
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
authors.forename: Nicolás
authors.initials: N
authors.lastname: Nin
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Davies
authors.forename: Pravin
authors.initials: P
authors.lastname: Amin
authors.forename: Bin
authors.initials: B
authors.lastname: Du
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Raymondos
authors.forename: Fernando
authors.initials: F
authors.lastname: Rios
authors.forename: Damian A
authors.initials: DA
authors.lastname: Violi
authors.forename: Salvatore M
authors.initials: SM
authors.lastname: Maggiore
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Soares
authors.forename: Marco
authors.initials: M
authors.lastname: González
authors.forename: Fekri
authors.initials: F
authors.lastname: Abroug
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Bülow
authors.forename: Javier
authors.initials: J
authors.lastname: Hurtado
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuiper
authors.forename: Rui P
authors.initials: RP
authors.lastname: Moreno
authors.forename: Amine Ali
authors.initials: AA
authors.lastname: Zeggwagh
authors.forename: Asisclo J
authors.initials: AJ
authors.lastname: Villagómez
authors.forename: Manuel
authors.initials: M
authors.lastname: Jibaja
authors.forename: Luis
authors.initials: L
authors.lastname: Soto
authors.forename: Gabriel
authors.initials: G
authors.lastname: D'Empaire
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Matamis
authors.forename: Younsuck
authors.initials: Y
authors.lastname: Koh
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
authors.forename: Niall D
authors.initials: ND
authors.lastname: Ferguson
authors.forename: Andrés
authors.initials: A
authors.lastname: Esteban
mesh_terms: D000368:Aged; D000698:Analgesia; D000700:Analgesics / Q000627:therapeutic use*; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation; D011446:Prospective Studies; D017211:Treatment Failure
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives