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Intensive Care Medicine
Published in: Intensive Care Medicine 1/2007

01-01-2007 | Original

Remifentanil-based sedation to treat noninvasive ventilation failure: a preliminary study

Authors: Jean-Michel Constantin, Eric Schneider, Sophie Cayot-Constantin, Renaud Guerin, Francois Bannier, Emmanuel Futier, Jean-Etienne Bazin

Published in: Intensive Care Medicine | Issue 1/2007

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Abstract

Objective

To assess the feasibility and safety of remifentanil-based sedation during noninvasive ventilation (NIV) in patients with NIV failure.

Design and setting

Prospective clinical investigation in a 16-bed intensive care unit of a university hospital in France.

Patients

Thirteen patients in NIV failure due to discomfort and/or refusal to continue this ventilatory support: 10 with acute respiratory failure and 3 with acute hypercapnic respiratory failure.

Intervention

Patients were administered methylene blue and were sedated (Ramsay scale 2–3) by a continuous perfusion of remifentanil during NIV. Cardiorespiratory and ventilatory parameters, blood gas analysis, and adverse events were prospectively recorded.

Measurements and results

The 13 patients received a total of 125 NIV sessions, totaling 1200 h, of NIV under remifentanil-based sedation (mean remifentanil dose 0.1 ± 0.03 μg/kg per minute). Three patients also required propofol. PaO2/FIO2 ratio increased from 134 ± 69 to 187 ± 43 mmHg after 1 h. In patients with acute respiratory failure respiratory rate decreased from 34 ± 12 per minute before remifentanil to 25 ± 4 per minute after 1 h. In the three patients with acute hypercapnic respiratory failure PaCO2 decreased from 69 ± 7 to 42 ± 5 mmHg. Four patients required endotracheal intubation without aspiration pneumonia. Twelve of the 13 patients left the ICU.

Conclusion

This pilot study shows that remifentanil-based sedation is safe and effective in the treatment of NIV failure due to low tolerance.
Literature
1.
Carlucci A, Richard JC, Wysocki M, Lepage E, Brochard L, SRLF Collaborative Group on Mechanical Ventilation (2001) Noninvasive versus conventional mechanical ventilation. An epidemiologic survey. Am J Respir Crit Care Med 163:874–880PubMed
2.
Bonmarchand G, Girault C (2001) Acute respiratory failure in patients with chronic respiratory insufficiency. Rev Prat 51:1094–1100PubMed
3.
Keenan SP, Kernerman PD, Cook DJ, Martin CM, McCormack D, Sibbald WJ (1997) Effect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure: a meta-analysis. Crit Care Med 25:1685–1692PubMedCrossRef
4.
Sinuff T (2002) Review: noninvasive ventilation reduces mortality in acute respiratory failure. ACP J Club 137:50PubMed
5.
Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487PubMedCrossRef
6.
Girou E, Brun-Buisson C, Taille S, Lemaire F, Brochard L (2003) Secular trends in nosocomial infections and mortality associated with noninvasive ventilation in patients with exacerbation of COPD and pulmonary edema. JAMA 290:2985–2991PubMedCrossRef
7.
Nourdine K, Combes P, Carton MJ, Beuret P, Cannamela A, Ducreux JC (1999) Does noninvasive ventilation reduce the ICU nosocomial infection risk? A prospective clinical survey. Intensive Care Med 25:567–573PubMedCrossRef
8.
Conti G, Arcangeli A, Antonelli M, Cavaliere F, Costa R, Simeoni F, Proietti R (2004) Sedation with sufentanil in patients receiving pressure support ventilation has no effects on respiration: a pilot study. Can J Anaesth 51:494–49PubMed
9.
Conti G, Costa R, Pellegrini A, Craba A, Cavaliere F (2005) Analgesia in PACU: intravenous opioids. Curr Drug Targets 6:767–771PubMedCrossRef
10.
Ethuin F, Boudaoud S, Leblanc I, Troje C, Marie O, Levron JC, Le Moing JP, Assoune P, Eurin B, Jacob L (2003) Pharmacokinetics of long-term sufentanil infusion for sedation in ICU patients. Intensive Care Med 29:1916–1920PubMedCrossRef
11.
Brochard L (1996) Non-invasive modalities of mechanical ventilation. Presse Med 25:1407–1409PubMed
12.
Hoke JF, Shlugman D, Dershwitz M, Michalowski P, Malthouse-Dufore S, Connors PM, Martel D, Rosow CE, Muir KT, Rubin N, Glass PS (1997) Pharmacokinetics and pharmacodynamics of remifentanil in persons with renal failure compared with healthy volunteers. Anesthesiology 87:533–541PubMedCrossRef
13.
Kuhlen R, Putensen C (2004) Remifentanil for analgesia-based sedation in the intensive care unit. Crit Care 8:13–14PubMedCrossRef
14.
Ramsay MA, Macaluso A, Tillmann Hein HA, Cancemi E (1998) Use of remifentanil in patients breathing spontaneously during monitored anesthesia care and in the management of acute postoperative care. Anesthesiology 88:1124–1126PubMedCrossRef
15.
Ramsay MA, Savege TM, Simpson BR, Goodwin R (1974) Controlled sedation with alphaxalone-alphadolone. BMJ 2:656–659PubMedCrossRef
16.
Jaber S, Chanques G, Matecki S, Ramonatxo M, Souche B, Perrigault PF, Eledjam JJ (2002) Comparison of the effects of heat and moisture exchangers and heated humidifiers on ventilation and gas exchange during non-invasive ventilation. Intensive Care Med 28:1590–1594PubMedCrossRef
17.
Lellouche F, Maggiore SM, Deye N, Taille S, Pigeot J, Harf A, Brochard L (2002) Effect of the humidification device on the work of breathing during noninvasive ventilation. Intensive Care Med 28:1582–1589PubMedCrossRef
18.
Rocker GM, Mackenzie MG, Williams B, Logan PM (1999) Noninvasive positive pressure ventilation: successful outcome in patients with acute lung injury/ARDS. Chest 115:173–177PubMedCrossRef
19.
Cavaliere F, Antonelli M, Arcangeli A, Conti G, Costa R, Pennisi MA, Proietti R (2002) A low-dose remifentanil infusion is well tolerated for sedation in mechanically ventilated, critically-ill patients. Can J Anaesth 49:1088–1094PubMedCrossRef
20.
Bilgin H, Basagan Mogol E, Bekar A, Iscimen R, Korfali G (2006) A comparison of effects of alfentanil, fentanyl, and remifentanil on hemodynamic and respiratory parameters during stereotactic brain biopsy. J Neurosurg Anesthesiol 18:179–184PubMedCrossRef
21.
Arunasalam K, Davenport HT, Painter S, Jones JG (1983) Ventilatory response to morphine in young and old subjects. Anaesthesia 38:529–533PubMed
22.
Babenco HD, Conard PF, Gross JB (2000) The pharmacodynamic effect of a remifentanil bolus on ventilatory control. Anesthesiology 92:393–398PubMedCrossRef
23.
Janssens JP, Howarth-Frey C, Chevrolet JC, Abajo B, Rochat T (1998) Transcutaneous PCO2 to monitor noninvasive mechanical ventilation in adults: assessment of a new transcutaneous PCO2 device. Chest 113:768–773PubMed
24.
Janssens JP, Perrin E, Bennani I, de Muralt B, Titelion V, Picaud C (2001) Is continuous transcutaneous monitoring of PCO2 (TcPCO2) over 8 h reliable in adults? Respir Med 95:331–335PubMedCrossRef
25.
De Castro V, Godet G, Mencia G, Raux M, Coriat P (2003) Target-controlled infusion for remifentanil in vascular patients improves hemodynamics and decreases remifentanil requirement. Anesth Analg 96:33–38PubMedCrossRef
26.
Mertens MJ, Engbers FH, Burm AG, Vuyk J (2003) Predictive performance of computer-controlled infusion of remifentanil during propofol/remifentanil anaesthesia. Br J Anaesth 90:132–141PubMedCrossRef
27.
Nieuwenhuijs DJ, Olofsen E, Romberg RR, Sarton E, Ward D, Engbers F, Vuyk J, Mooren R, Teppema LJ, Dahan A (2003) Response surface modeling of remifentanil-propofol interaction on cardiorespiratory control and bispectral index. Anesthesiology 98:312–322PubMedCrossRef
Metadata
Title
Remifentanil-based sedation to treat noninvasive ventilation failure: a preliminary study
Authors
Jean-Michel Constantin
Eric Schneider
Sophie Cayot-Constantin
Renaud Guerin
Francois Bannier
Emmanuel Futier
Jean-Etienne Bazin
Publication date
01-01-2007
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 1/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-006-0447-4

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