Role of Sedation and Analgesia During Noninvasive Ventilation: Systematic Review of Recent Evidence and Recommendations

Overview

Journal Indian J Crit Care Med

Specialty Critical Care

Date 2022 Aug 31

PMID 36042773

Authors

Habib Mr Karim

Irena Sarc

Camilla Calandra

Savino Spadaro

Bushra Mina

Laura D Ciobanu

Gil Goncalves

Vania Caldeira

Bruno Cabrita

Andreas Perren

Giuseppe Fiorentino

Tughan Utku

Edoardo Piervincenzi

Mohamad El-Khatib

Nilgun Alpay

Rodolfo Ferrari

Mohamed Ea Abdelrahim

Haitham Saeed

Yasmin M Madney

Hadeer S Harb

Nicola Vargas

Hilmi Demirkiran

Pradipta Bhakta

Peter Papadakos

Manuel A Gomez-Rios

Alfredo Abad

Jaber S Alqahtani

Vijay Hadda

Subrata K Singha

Antonio M Esquinas

Affiliations

Soon will be listed here.

Abstract

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.

How To Cite This Article: Karim HMR, Šarc I, Calandra C, Spadaro S, Mina B, Ciobanu LD, et al. 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.

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