Cic edizioni internazionali
Shortness of Breath

Sedation during non-invasive ventilation to treat acute respiratory failure

Mini-Review, 35 - 43
doi: 10.11138/sob/2013.2.1.035
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Despite the increase popularity of noninvasive ventilation (NIV) to treat acute respiratory failure (ARF), up to a quarter of patients fails because of poor adherence or refusal to the ventilator treatment and therefore endotracheal intubation (ETI) with conventional mechanical ventilation (CMV) is required. The implementation of sedation-based strategy to rescue patients with poor co-operation and/or adaptation to NIV is appealing to enlarge its rate of success. Pilot studies suggest that continuous infusion of a single different sedative and analgesic agent titrated to obtain “conscious sedation” may decrease patient discomfort, with no significant effects on respiratory drive, respiratory pattern, or hemodynamic; in addition, gas exchange improve under NIV plus sedation.
Despite these encouraging findings, the level of the evidence in favor of a large application of sedation during NIV is still limited and further larger and controlled trials are needed to clarify the indications of sedation during NIV and better select the patients who are mostly likely to benefit from this practice.
Careful selection of candidates, setting of application, expertise of the team and capability of prompting intubating the patients are the key-ingredients necessary for attempting in safety this procedure which should be implemented within a strategy aimed at reducing the risk of NIV failure in poor tolerant subjects.