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Review
. 2014 Nov 4;9(1):56.
doi: 10.1186/2049-6958-9-56. eCollection 2014.

Sedation in non-invasive ventilation: do we know what to do (and why)?

Dan Longrois  1 , Giorgio Conti  2 , Jean Mantz  3 , Andreas Faltlhauser  4 , Riku Aantaa  5 , Peter Tonner  6
Affiliations
Review

Sedation in non-invasive ventilation: do we know what to do (and why)?

Dan Longrois et al. Multidiscip Respir Med. .

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.

Keywords: Agitation; Benzodiazepines; Delirium; Dexmedetomidine; Dyspnoea; Ketamine; Non-invasive ventilation; Opioids; Propofol; Sedation.

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Figures

Figure 1
Figure 1
Clinical reasoning pathway for the use of sedation in NIV.
See this image and copyright information in PMC

References

    1. Keenan SP, Sinuff T, Burns KE, Muscedere J, Kutsogiannis J, Mehta S, Cook DJ, Ayas N, Adhikari NK, Hand L, Scales DC, Pagnotta R, Lazosky L, Rocker G, Dial S, Laupland K, Sanders K, Dodek P, Canadian Critical Care Trials Group/Canadian Critical Care Society Noninvasive Ventilation Guidelines Group Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ. 2011;183:E195–E214. doi: 10.1503/cmaj.100071. - DOI - PMC - PubMed
    1. Burns KE, Meade MO, Premji A, Adhikari NK. Noninvasive ventilation as a weaning strategy for mechanical ventilation in adults with respiratory failure: a Cochrane systematic review. CMAJ. 2014;186:E112–E122. doi: 10.1503/cmaj.130974. - DOI - PMC - PubMed
    1. Burns KE, Meade MO, Premji A, Adhikari NK. Cochrane Database Syst Rev. 2013. Noninvasive positive-pressure ventilation as a weaning strategy for intubated adults with respiratory failure. - PMC - PubMed
    1. Hill NS, Lin D, Levy M, O’Brien A, Klinger J, Houtchens J, Nelson D, McCormick J. Noninvasive positive pressure ventilation (NPPV) to facilitate extubation after acute respiratory failure: a feasibility study [abstract] Am J Respir Crit Care Med. 2000;161:B18.
    1. Nava S, Ambrosino N, Clini E, Prato M, Orlando G, Vitacca M, Brigada P, Fracchia C, Rubini F. Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease: a randomized, controlled trial. Ann Intern Med. 1998;128:721–728. doi: 10.7326/0003-4819-128-9-199805010-00004. - DOI - PubMed

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