Dexmedetomidine-based sedation for noninvasive ventilation failure

Introduction

Noninvasive ventilation (NIV) reduces the intubation and mortality in patients with acute on chronic respiratory failure. NIV is associated with a large number of failures, and with patient refusal. The purpose of the study was to assess the feasibility and safety of dexmedetomidine-based sedation during NIV.

Methods

In this prospective, randomised controlled study, patients on NIV support with agitation and ventilatory discomfort were included. The patients were allocated randomly into two groups: dexmedetomidine (Dex) and control. In the Dex group, the infusion rate was 0.2–0.7 μg/kg/hour to reach a Ramsey sedation score (RSS) between 3 and 4. Haemodynamic and respiratory characteristics, and the RSS were documented at 1 minute, 10 minutes, 30 minutes, 1 hour, 4 hours and 24 hours after Dex infusion was started. When additional sedation was needed 0.02–0.03 mg/kg intravenous midazolam was used. Spontaneous ventilation and NIV support durations, the total infusion time (hours), the total Dex consumption, the reason for infusion therapy cessation, additional sedative agent requirements, and the duration of the mechanical ventilation were documented.

Results

Thirty patients under NIV support with agitation and ventilatory discomfort were included in this study. The results in the Dex group are summarized in Table 1. Additional sedative agent requirement was significantly higher in the control group. Side effects such as hypotension and hypoglycemia were found in the Dex group.

Table 1 Respiratory, haemodynamic characteristics and Ramsey sedation score variables

Conclusion

Dexmedetomidine is safe and effective for the sedation of the patients under NIV support.