Sedation in non-invasive ventilation: do we know what to do (and why)?

Dan Longrois; Giorgio Conti; Jean Mantz; Andreas Faltlhauser; Riku Aantaa; Peter Tonner

doi:10.4081/mrm.2014.391

Sedation in non-invasive ventilation: do we know what to do (and why)?

Authors

Dan Longrois Université Paris-Diderot, Hôpitaux Universitaires Paris Nord Val de Seine, Département d'Anesthésie Réanimation Chirurgicale, Hôpital Bichat-Claude Bernard, Paris
Giorgio Conti Department of Intensive Care and Anesthesiology, Università Cattolica del Sacro Cuore, Rome
Jean Mantz Anesthesiology Department, Beaujon Hospital, AP-HP, Université Paris-Diderot, Paris
Andreas Faltlhauser First Department of Internal Medicine, Kliniken Nordoberpfalz AG, Klinikum Weiden, Weiden
Riku Aantaa Department of Anesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku, Turku
Peter Tonner Department of Anesthesiology and Intensive Care Medicine, Emergency Medicine Hospital Links der Weser GmbH, Bremen

DOI: https://doi.org/10.4081/mrm.2014.391

Keywords:

Agitation, Benzodiazepines, Delirium, Dexmedetomidine, Dyspnoea, Ketamine, Non-invasive ventilation, Opioids, Propofol, Sedation

Abstract

This review examines some of the issues encountered in the use of sedation in patients receiving respiratory support from non-invasive ventilation (NIV). This is an area of critical and intensive care medicine where there are limited (if any) robust data to guide the development of best practice and where local custom appears to exert a strong influence on patterns of care. We examine aspects of sedation for NIV where the current lack of structure may be contributing to missed opportunities to improve standards of care and examine the existing sedative armamentarium. No single sedative agent is currently available that fulfils the criteria for an ideal agent but we offer some observations on the relative merits of different agents as they relate to considerations such as effects on respiratory drive and timing, and airways patency. The significance of agitation and delirium and the affective aspect(s) of dyspnoea are also considered.
We outline an agenda for placing the use of sedation in NIV on a more systematic footing, including clearly expressed criteria and conditions for terminating NIV and structural and organizational conditions for prospective multicentre trials.