Remifentanil provides an increased proportion of time under light sedation than fentanyl when combined with dexmedetomidine for mechanical ventilation

Abstract

Objective: To compare the effects of remifentanil versus fentanyl during light sedation with dexmedetomidine in adults receiving mechanical ventilation (MV) in the intensive care unit.

Methods: In this retrospective cohort study, we compared the use of remifentanil versus fentanyl in adults receiving MV with dexmedetomidine sedation. The primary outcome was the proportion of time under light sedation (Richmond Agitation-Sedation Scale score between -1 and 0) during MV.

Results: We included 94 patients and classified 58 into the remifentanil group and 36 into the fentanyl group. The mean proportion of time under light sedation during MV was 66.6% ± 18.5% in the remifentanil group and 39.9% ± 27.3% in the fentanyl group. In the multivariate analysis with control for confounding factors, patients in the remifentanil group showed a significantly higher proportion of time under light sedation than patients in the fentanyl group (mean difference: 24.3 percentage points; 95% confidence interval: 12.9-35.8).

Conclusions: Remifentanil use might increase the proportion of time under light sedation in patients receiving MV compared with fentanyl administration.

Keywords: Light sedation; dexmedetomidine; fentanyl; mechanical ventilation; opioid; remifentanil.

Figure 1.

Flowchart of the study. ICU, intensive care unit.

Figure 2.

Distribution of Richmond Agitation–Sedation Scale (RASS) scores in patients admitted to the ICU who received mechanical ventilation under sedation with dexmedetomidine combined with remifentanil or fentanyl. Comparing RASS scores between the remifentanil and fentanyl groups revealed a significant difference for a RASS score of −1 (P < 0.001; Wilcoxon rank-sum test, Bonferroni post hoc test); the differences for the other RASS scores were not significant. RASS, Richmond Agitation–Sedation Scale; ICU, intensive care unit.