Remifentanil-based sedation to treat noninvasive ventilation failure: A preliminary study

Abstract

Objective: To assess the feasibility and safety of remifentanil-based sedation during noninvasive ventilation (NIV) in patients with NIV failure. Design and setting: Prospective clinical investigation in a 16-bed intensive care unit of a university hospital in France. Patients: Thirteen patients in NIV failure due to discomfort and/or refusal to continue this ventilatory support: 10 with acute respiratory failure and 3 with acute hypercapnic respiratory failure. Intervention: Patients were administered methylene blue and were sedated (Ramsay scale 2-3) by a continuous perfusion of remifentanil during NIV. Cardiorespiratory and ventilatory parameters, blood gas analysis, and adverse events were prospectively recorded. Measurements and results: The 13 patients received a total of 125 NIV sessions, totaling 1200 h, of NIV under remifentanil-based sedation (mean remifentanil dose 0.1 ± 0.03 μg/kg per minute). Three patients also required propofol. PaO2/FIO 2 ratio increased from 134 ± 69 to 187 ± 43 mmHg after 1 h. In patients with acute respiratory failure respiratory rate decreased from 34 ± 12 per minute before remifentanil to 25 ± 4 per minute after 1 h. In the three patients with acute hypercapnic respiratory failure PaCO 2 decreased from 69 ± 7 to 42 ± 5 mmHg. Four patients required endotracheal intubation without aspiration pneumonia. Twelve of the 13 patients left the ICU. Conclusion: This pilot study shows that remifentanil-based sedation is safe and effective in the treatment of NIV failure due to low tolerance. © 2006 Springer-Verlag.