The online version of this article (doi:10.1186/s12890-015-0072-5) contains supplementary material, which is available to authorized users.
KC belongs to The Department of Respiratory Care and Sleep Control Medicine which is funded by endowments from Philips-Respironics, Teijin Pharma, Fukuda Denshi, and Fukuda Lifetec Keiji to Kyoto University. The other authors declare that they have no competing interests.
TM contributed to the study design, collection of data, analysis and interpretation of data, and writing the manuscript. KT, RT and KO contributed to the study design, collection of data and editing the draft. KN, KO and AN contributed to the study design and collection of data. MM contributed to the study design and study supervision. KC contributed to the study design and editing the draft. All authors read and approved the final manuscript.
Although sedation is often required for agitated patients undergoing noninvasive ventilation (NIV), reports on its practical use have been few. This study aimed to evaluate the efficacy and safety of sedation for agitated patients undergoing NIV in clinical practice in a single hospital.
We retrospectively reviewed sedated patients who received NIV due to acute respiratory failure from May 2007 to May 2012. Sedation level was controlled according to the Richmond Agitation Sedation Scale (RASS). Clinical background, sedatives, failure rate of sedation, and complications were evaluated by 1) sedative methods (intermittent only, switched to continuous, or initially continuous) and 2) code status (do-not-intubate [DNI] or non-DNI).
Of 3506 patients who received NIV, 120 (3.4 %) consecutive patients were analyzed. Sedation was performed only intermittently in 72 (60 %) patients, was switched to continuously in 37 (31 %) and was applied only continuously in 11 (9 %). Underlying diseases in 48 % were acute respiratory distress syndrome/acute lung injury/severe pneumonia or acute exacerbation of interstitial pneumonia. In non-DNI patients (n = 39), no patient required intubation due to agitation with continuous sedation, and in DNI patients (n = 81), 96 % of patients could continue NIV treatment. PaCO2 level changes (6.7 ± 15.1 mmHg vs. -2.0 ± 7.7 mmHg, P = 0.028) and mortality in DNI patients (81 % vs. 57 %, P = 0.020) were significantly greater in the continuous use group than in the intermittent use group.
According to RASS scores, sedation during NIV in proficient hospitals may be favorably used to potentially avoid NIV failure in agitated patients, even in those having diseases with poor evidence of the usefulness of NIV. However, with continuous use, we must be aware of an increased hypercapnic state and the possibility of increased mortality. Larger controlled studies are needed to better clarify the role of sedation in improving NIV outcomes in intolerant patients.
Additional file 1: Changes in RASS score, respiratory rate, heart rate, and systolic blood pressure before and after the start of sedation. RASS, Richmond Agitation Sedation Scale.12890_2015_72_MOESM1_ESM.xlsx
Additional file 2: Changes in pH and P/F ratio within 24 h after initiation of each sedative. P/F, PaO2/FiO2. *Comparison of change in pH and PaO2/FiO2 ratio between intermittent and continuous use groups.12890_2015_72_MOESM2_ESM.xlsx
- Role of sedation for agitated patients undergoing noninvasive ventilation: clinical practice in a tertiary referral hospital
- BioMed Central
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