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

Intensive Care Med (2007) 33:8287DOI 10.1007/s00134-006-0447-4 ORIGINAL

Jean-Michel Constantin Eric Schneider Sophie Cayot-Constantin Renaud Guerin Francois Bannier Emmanuel Futier Jean-Etienne Bazin

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

Received: 16 February 2006 Accepted: 10 October 2006 Published online: 14 November 2006 Springer-Verlag 2006

J.-M. Constantin ( ) E. Schneider S. Cayot-Constantin R. Guerin F. Bannier E. Futier J.-E. Bazin Htel-Dieu Hospital, CHU Clermont-Ferrand, Service de Reanimation Adulte,63058 Clermont-Ferrand, Francee-mail: [email protected].: [phone]Fax: [phone]

J.-M. ConstantinINSERM,U384, 63001 Clermont-Ferrand, France

J.-E. BazinUniv Clermont 1, Fac Medecine, 63001 Clermont-Ferrand, France

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 23) 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 g/kg per minute). Three patients also required propofol. PaO2/FIO2 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 PaCO2 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.

Keywords Noninvasive ventilation Acute respiratory failure Mechanical ventilation Remifentanil Critical care Sedation

Introduction Recent studies have shown that noninvasive ventilation (NIV) reduces the risk of pneumonia [1], barotraumas [2] and even mortality in patients with acute respiratory failure [3, 4], particularly in immunosuppressed patients [5]. Girou et al. [6] recently demonstrated that implementing routine use of NIV in critically ill...