Remifentanil Versus Dexmedetomidine for Treatment of Cardiac Surgery Patients with Moderate to Severe Noninvasive Ventilation Intolerance (REDNIVIN): a Prospective, Cohort Study

Overview

Journal J Thorac Dis

Publisher AME Publishing Company

Specialty Pulmonary Medicine

Date 2020 Nov 19

PMID 33209418

Citations 5

Authors

Guang-Wei Hao

Jing-Chao Luo

Yan Xue

Guo-Guang Ma

Ying Su

Jun-Yi Hou

Shen-Ji Yu

Kai Liu

Ji-Li Zheng

Guo-Wei Tu

Zhe Luo

Affiliations

Soon will be listed here.

Abstract

Background: The use of sedation to noninvasive ventilation (NIV) patients remains controversial, however, for intolerant patients who are uncooperative, administration of analgesics and sedatives may be beneficial before resorting to intubation. The aim of this study was to evaluate the efficacy of remifentanil (REM) versus dexmedetomidine (DEX) for treatment of cardiac surgery (CS) patients with moderate to severe NIV intolerance.

Methods: This prospective cohort study of CS patients with moderate to severe NIV intolerance was conducted between January 2018 and March 2019. Patients were treated with either REM or DEX, decided by the bedside intensivist. Depending on the treatment regimen, the patients were allocated to one of two groups: the REM group or DEX group.

Results: A total of 90 patients were enrolled in this study (52 in the REM group and 38 in the DEX group). The mitigation rate, defined as the percentage of patients who were relieved from the initial moderate to severe intolerant status, was greater in the REM group than DEX group at 15 min and 3 h (15 min: 83% 61%, P=0.029; 3 h: 92% 74%, P=0.016), although the mean mitigation rate (81% 85%, P=0.800) was comparable between the two groups. NIV failure, defined as reintubation or death over the course of study, was comparable between the two groups (19.2% 21.1%, respectively, P=0.831). There were no significant differences between the two groups in other clinical outcomes, including tracheostomy (15.4% 15.8%, P=0.958), in-hospital mortality (11.5% 10.5%, P=0.880), ICU length of stay (LOS) (7 7 days, P=0.802), and in-hospital LOS (17 19 days, P=0.589).

Conclusions: REM was as effective as DEX in CS patients with moderate to severe NIV intolerance. Although the effect of REM was better than that of DEX over the first 3 h, the cumulative effect was similar between the two treatments.

Citing Articles

Remifentanil vs. dexmedetomidine for cardiac surgery patients with noninvasive ventilation intolerance: a multicenter randomized controlled trial.

Hao G, Wu J, Yu S, Liu K, Xue Y, Gong Q J Intensive Care. 2024; 12(1):35.

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Randomized single-blinded study comparing sedation effectiveness and hemodynamic stability of remifentanil vs dexmedetomidine infusion for electrophysiology procedures in patients of National Heart Institute cathlab.

Hassan R, Mutalib A, Shang C, Sachdev N, Rahman F, Ling E J Interv Card Electrophysiol. 2024; 67(8):1735-1743.

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Analgo-sedation in Patients on Non-invasive Mechanical Ventilation: Need for Guideline Recommendation.

V S, Marwah V, Jyothis M Indian J Crit Care Med. 2024; 28(3):309-310.

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Comparison of clinical safety and efficacy of dexmedetomidine, remifentanil, and propofol in patients who cannot tolerate non-invasive mechanical ventilation: A prospective, randomized, cohort study.

Altinkaya Cavus M, Gokbulut Bektas S, Turan S Front Med (Lausanne). 2022; 9:995799.

PMID: 36111123 PMC: 9468549. DOI: 10.3389/fmed.2022.995799.

Comfort During Non-invasive Ventilation.

Cammarota G, Simonte R, De Robertis E Front Med (Lausanne). 2022; 9:874250.

PMID: 35402465 PMC: 8988041. DOI: 10.3389/fmed.2022.874250.

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