Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 Jul 1;52(7):1043-1053.
doi: 10.1097/CCM.0000000000006253. Epub 2024 Mar 20.

Analgesia and Sedation Use During Noninvasive Ventilation for Acute Respiratory Failure

Peter J Dunbar  1 , Ryan Peterson  2 , Max McGrath  2 , Raymond Pomponio  2 , Tyree H Kiser  3 , P Michael Ho  4 , R William Vandivier  1 , Ellen L Burnham  1 , Marc Moss  1 , Peter D Sottile  1 ; Colorado Pulmonary Outcomes Research Group
Affiliations
Multicenter Study

Analgesia and Sedation Use During Noninvasive Ventilation for Acute Respiratory Failure

Peter J Dunbar et al. Crit Care Med. .

Abstract

Objectives: To describe U.S. practice regarding administration of sedation and analgesia to patients on noninvasive ventilation (NIV) for acute respiratory failure (ARF) and to determine the association of this practice with odds of intubation or death.

Design: A retrospective multicenter cohort study.

Setting: A total of 1017 hospitals contributed data between January 2010 and September 2020 to the Premier Healthcare Database, a nationally representative healthcare database in the United States.

Patients: Adult (≥ 18 yr) patients admitted to U.S. hospitals requiring NIV for ARF.

Interventions: None.

Measurements and main results: We identified 433,357 patients on NIV of whom (26.7% [95% CI] 26.3%-27.0%) received sedation or analgesia. A total of 50,589 patients (11.7%) received opioids only, 40,646 (9.4%) received benzodiazepines only, 20,146 (4.6%) received opioids and benzodiazepines, 1.573 (0.4%) received dexmedetomidine only, and 2,639 (0.6%) received dexmedetomidine in addition to opioid and/or benzodiazepine. Of 433,357 patients receiving NIV, 50,413 (11.6%; 95% CI, 11.5-11.7%) patients underwent invasive mechanical ventilation on hospital days 2-5 or died on hospital days 2-30. Intubation was used in 32,301 patients (7.4%; 95% CI, 7.3-7.6%). Further, death occurred in 24,140 (5.6%; 95% CI, 5.5-5.7%). In multivariable analysis adjusting for relevant covariates, receipt of any medication studied was associated with increased odds of intubation or death. In inverse probability weighting, receipt of any study medication was also associated with increased odds of intubation or death (average treatment effect odds ratio 1.38; 95% CI, 1.35-1.40).

Conclusions: The use of sedation and analgesia during NIV is common. Medication exposure was associated with increased odds of intubation or death. Further investigation is needed to confirm this finding and determine whether any subpopulations are especially harmed by this practice.

PubMed Disclaimer

Conflict of interest statement

This article was supported by an Institutional National Research Service Award (T32) funded by the National Institute of Health, National Heart, Lung, and Blood Institute (T32 HL007085). Dr. Ho disclosed government work. Dr. Sottile’s institution received funding from the National Heart, Lung, and Blood Institute; he received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. Rochwerg B, Brochard L, Elliott MW, et al.: Official ERS/ATS clinical practice guidelines: Noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017; 50:1602426
    1. Mehta AB, Douglas IS, Walkey AJ: Evidence-based utilization of noninvasive ventilation and patient outcomes. Ann Am Thorac Soc. 2017; 14:1667–1673
    1. Bellani G, Laffey JG, Pham T, et al.; LUNG SAFE Investigators: Noninvasive ventilation of patients with acute respiratory distress syndrome. Insights from the LUNG SAFE study. Am J Respir Crit Care Med. 2017; 195:67–77
    1. Thille AW, Countou D, Fragnloi C, et al.: Non-invasive ventilation for acute hypoxemic respiratory failure: Intubation rate and risk factors. Crit Care. 2013; 17:R269
    1. Walkey AJ, Wiener RS: Use of noninvasive ventilation in patients with acute respiratory failure, 2000-2009: A population-based study. Ann Am Thorac Soc. 2013; 10:10–17

Publication types

MeSH terms

LinkOut - more resources