Rescue treatment for noninvasive ventilation failure due to interface intolerance with remifentanil analgosedation: a pilot study

• Published in: Intensive care medicine 2010-12, Vol.36 (12), p.2060-2065
• Main Authors: Rocco, Monica, Conti, Giorgio, Alessandri, Elisa, Morelli, Andrea, Spadetta, Gustavo, Laderchi, Amalia, Di Santo, Carmela, Francavilla, Samanta, Pietropaoli, Paolo
• Format: Article
• Language: English
• Subjects: Acute Disease; Acute respiratory distress syndrome; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Care and treatment; Critical Care Medicine; Emergency and intensive respiratory care; Emergency Medicine; Feasibility Studies; Female; Humans; Hypnotics and Sedatives - therapeutic use; Intensive; Intensive care medicine; Male; Masks; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Original; Pain Medicine; Pediatrics; Pilot Projects; Piperidines - therapeutic use; Pneumology/Respiratory System; Positive-Pressure Respiration - adverse effects; Positive-Pressure Respiration - instrumentation; Prospective Studies; Remifentanil; Respiratory Insufficiency - therapy; Sufentanil; Treatment Failure; Treatment Refusal
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-010-2026-y

Purpose To assess the feasibility of remifentanil-based sedation in hypoxemic acute respiratory failure (HARF) patients refusing to continue noninvasive ventilation (NPPV) for intolerance to two different interfaces—helmet and total face mask. Design and setting Prospective uncontrolled clinical investigation in a 14-bed ICU of an university hospital in Italy. Patients Thirty-six patients with persistent severe HARF who complained of discomfort and asked for interruption of NPPV session. Intervention Patients started sedation with remifentanil (0.025 μg kg −1  min −1 ) and the infusion rate was increased by 0.01 μg kg −1  min −1 every minute to a maximum of 0.12 μg kg −1  min −1 to obtain patient comfort. Measurements and results Twenty-two out of 36 patients (61%) with median (IQR) SAPS II score of 32 (30, 38) continued the NPPV treatment after the introduction of remifentanil infusion. In this success group, median (IQR) respiratory rate decreased from 34 (31, 37) to 24 (20, 26) min −1 ( p