Role of Sedation and Analgesia during Noninvasive Ventilation: Systematic Review of Recent Evidence and Recommendations
Irena Šarc, Camilla Calandra, Savino Spadaro, Bushra Mina, Laura D Ciobanu, Gil Gonçalves, Vania Caldeira, Bruno Cabrita, Andreas Perren, Giuseppe Fiorentino, Tughan Utku, Edoardo Piervincenzi, Mohamad El-Khatib, Nilgün Alpay, Rodolfo Ferrari, Mohamed EA Abdelrahim, Haitham Saeed, Yasmin M Madney, Hadeer S Harb, Nicola Vargas, Hilmi Demirkiran, Pradipta Bhakta, Peter Papadakos, Manuel Á Gómez-Ríos, Alfredo Abad, Subrata K Singha
Citation Information :
Šarc I, Calandra C, Spadaro S, Mina B, Ciobanu LD, Gonçalves G, Caldeira V, Cabrita B, Perren A, Fiorentino G, Utku T, Piervincenzi E, El-Khatib M, Alpay N, Ferrari R, Abdelrahim ME, Saeed H, Madney YM, Harb HS, Vargas N, Demirkiran H, Bhakta P, Papadakos P, Gómez-Ríos MÁ, Abad A, Singha SK. Role of Sedation and Analgesia during Noninvasive Ventilation: Systematic Review of Recent Evidence and Recommendations. Indian J Crit Care Med 2022; 26 (8):938-948.
Aim: This systematic review aimed to investigate the drugs used and their potential effect on noninvasive ventilation (NIV).
Background: NIV is used increasingly in acute respiratory failure (ARF). Sedation and analgesia are potentially beneficial in NIV, but they can have a deleterious impact. Proper guidelines to specifically address this issue and the recommendations for or against it are scarce in the literature. In the most recent guidelines published in 2017 by the European Respiratory Society/American Thoracic Society (ERS/ATS) relating to NIV use in patients having ARF, the well-defined recommendation on the selective use of sedation and analgesia is missing. Nevertheless, some national guidelines suggested using sedation for agitation.
Methods: Electronic databases (PubMed/Medline, Google Scholar, and Cochrane library) from January 1999 to December 2019 were searched systematically for research articles related to sedation and analgosedation in NIV. A brief review of the existing literature related to sedation and analgesia was also done.
Review results: Sixteen articles (five randomized trials) were analyzed. Other trials, guidelines, and reviews published over the last two decades were also discussed. The present review analysis suggests dexmedetomidine as the emerging sedative agent of choice based on the most recent trials because of better efficacy with an improved and predictable cardiorespiratory profile.
Conclusion: Current evidence suggests that sedation has a potentially beneficial role in patients at risk of NIV failure due to interface intolerance, anxiety, and pain. However, more randomized controlled trials are needed to comment on this issue and formulate strong evidence-based recommendations.
Abbreviations: ACPE, acute cardiogenic pulmonary edema; AECOPD, acute exacerbation of the chronic obstructive pulmonary disease; AHRF, acute hypercapnic respiratory failure; ALI/ARDS, acute lung injury/acute respiratory distress syndrome; ARF, acute respiratory failure; COPD, chronic obstructive pulmonary disease; EAdi, electrical activity of the diaphragm; ERS/ATS, European Respiratory Society/American Thoracic Society; ETI, endotracheal intubation; ICU, intensive care unit; IMV, invasive mechanical ventilation; LOS, length of stay; NAVA, neurally adjusted ventilatory assist; NIV, noninvasive ventilation; PSV, pressure support ventilation; PVD, patient-ventilator dyssynchrony; RCT, randomized controlled trial.
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