Analgesia and Sedation Use During Noninvasive Ventilation for Acute Respiratory Failure.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
20 Mar 2024
20 Mar 2024
Historique:
medline:
20
3
2024
pubmed:
20
3
2024
entrez:
20
3
2024
Statut:
aheadofprint
Résumé
To describe U.S. practice regarding administration of sedation and analgesia to patients on noninvasive ventilation (NIV) for acute respiratory failure (ARF) and to determine the association of this practice with odds of intubation or death. A retrospective multicenter cohort study. A total of 1017 hospitals contributed data between January 2010 and September 2020 to the Premier Healthcare Database, a nationally representative healthcare database in the United States. Adult (≥ 18 yr) patients admitted to U.S. hospitals requiring NIV for ARF. None. We identified 433,357 patients on NIV of whom (26.7% [95% CI] 26.3%-27.0%) received sedation or analgesia. A total of 50,589 patients (11.7%) received opioids only, 40,646 (9.4%) received benzodiazepines only, 20,146 (4.6%) received opioids and benzodiazepines, 1.573 (0.4%) received dexmedetomidine only, and 2,639 (0.6%) received dexmedetomidine in addition to opioid and/or benzodiazepine. Of 433,357 patients receiving NIV, 50,413 (11.6%; 95% CI, 11.5-11.7%) patients underwent invasive mechanical ventilation on hospital days 2-5 or died on hospital days 2-30. Intubation was used in 32,301 patients (7.4%; 95% CI, 7.3-7.6%). Further, death occurred in 24,140 (5.6%; 95% CI, 5.5-5.7%). In multivariable analysis adjusting for relevant covariates, receipt of any medication studied was associated with increased odds of intubation or death. In inverse probability weighting, receipt of any study medication was also associated with increased odds of intubation or death (average treatment effect odds ratio 1.38; 95% CI, 1.35-1.40). The use of sedation and analgesia during NIV is common. Medication exposure was associated with increased odds of intubation or death. Further investigation is needed to confirm this finding and determine whether any subpopulations are especially harmed by this practice.
Identifiants
pubmed: 38506571
doi: 10.1097/CCM.0000000000006253
pii: 00003246-990000000-00310
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
Dr. Ho disclosed government work. Dr. Sottile’s institution received funding from the National Heart, Lung, and Blood Institute; he received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Références
Rochwerg B, Brochard L, Elliott MW, et al.: Official ERS/ATS clinical practice guidelines: Noninvasive ventilation for acute respiratory failure. Eur Respir J 2017; 50:1602426
Mehta AB, Douglas IS, Walkey AJ: Evidence-based utilization of noninvasive ventilation and patient outcomes. Ann Am Thorac Soc 2017; 14:1667–1673
Bellani G, Laffey JG, Pham T, et al.; LUNG SAFE Investigators: Noninvasive ventilation of patients with acute respiratory distress syndrome. Insights from the LUNG SAFE study. Am J Respir Crit Care Med 2017; 195:67–77
Thille AW, Countou D, Fragnloi C, et al.: Non-invasive ventilation for acute hypoxemic respiratory failure: Intubation rate and risk factors. Crit Care 2013; 17:R269
Walkey AJ, Wiener RS: Use of noninvasive ventilation in patients with acute respiratory failure, 2000-2009: A population-based study. Ann Am Thorac Soc 2013; 10:10–17
Duan J, Wang S, Liu P, et al.: Early prediction of noninvasive ventilation failure in COPD patients: Derivation, internal validation, and external validation of a simple risk score. Ann Intensive Care. 2019; 9:108
Cammarota G, Simonte R, De Robertis E: Comfort during non-invasive ventilation. Front Med. 2022; 9:874250
Conti G, Hill NS, Nava S: Is sedation safe and beneficial in patients receiving NIV? No. Intensive Care Med 2015; 41:1692–1695
Hilbert G, Navalesi P, Girault C: Is sedation safe and beneficial in patients receiving NIV? Yes. Intensive Care Med 2015; 41:1688–1691
Premier healthcare database white paper: Data that informs and performs. 2020
Parcha V, Kalra R, Bhatt SP, et al.: Trends and geographic variation in acute respiratory failure and ARDS mortality in the United States. Chest 2021; 159:1460–1472
Sottile PD, Kiser TH, Burnham EL, et al.; Colorado Pulmonary Outcomes Research Group (CPOR): An observational study of the efficacy of cisatracurium compared with vecuronium in patients with or at risk for acute respiratory distress syndrome. Am J Respir Crit Care Med 2018; 197:897–904
Devlin JW, Nava S, Fong JJ, et al.: Survey of sedation practices during noninvasive positive-pressure ventilation to treat acute respiratory failure. Crit Care Med 2007; 35:2298–2302
Lewis K, Piticaru J, Chaudhuri D, et al.: Safety and efficacy of dexmedetomidine in acutely ill adults requiring noninvasive ventilation: A systematic review and meta-analysis of randomized trials. Chest 2021; 159:2274–2288
Clouzeau B, Bui HN, Vargas F, et al.: Target-controlled infusion of propofol for sedation in patients with non-invasive ventilation failure due to low tolerance: A preliminary study. Intensive Care Med 2010; 36:1675–1680
Constantin JM, Schneider E, Cayot-Constantin S, et al.: Remifentanil-based sedation to treat noninvasive ventilation failure: A preliminary study. Intensive Care Med 2007; 33:82–87
Bosch NA, Law AC, Rucci JM, et al.: Predictive validity of the Sequential Organ Failure Assessment score versus claims-based scores among critically ill patients. Ann American Thoracic Soc 2022; 19:1072–1076
Mansour TA, Sharabiani A, Aylin P, et al.: Systematic review of comorbidity indices for administrative data. Med Care 2012; 50:1109–1118
Nadpara PA, Joyce AR, Murrelle EL, et al.: Risk factors for serious prescription opioid-induced respiratory depression or overdose: Comparison of commercially insured and veterans health affairs populations. Pain Med 2018; 19:79–96
Baillargeon J, Singh G, Kuo YF, et al.: Association of opioid and benzodiazepine use with adverse respiratory events in older adults with chronic obstructive pulmonary disease. Ann Am Thorac Soc 2019; 16:1245–1251
Dunbar PJ, Sottile PD, Moss M. The use of analgosedation in patients with acute respiratory failure requiring non-invasive positive pressure ventilation is associated with an increased risk of intubation and mortality. Am J Respir Crit Care Med 2023; 207:A2867
Rocco M, Conti G, Alessandri E, et al.: Rescue treatment for noninvasive ventilation failure due to interface intolerance with remifentanil analgosedation: A pilot study. Intensive Care Med 2010; 36:2060–2065
Senoglu N, Oksuz H, Dogan Z, et al.: Sedation during noninvasive mechanical ventilation with dexmedetomidine or midazolam: A randomized, double-blind, prospective study. Curr Ther Res Clin Exp 2010; 71:141–153
Huang Z, Chen YS, Yang ZL, et al.: Dexmedetomidine versus midazolam for the sedation of patients with non-invasive ventilation failure. Intern Med 2012; 51:2299–2305
Devlin JW, Al-Qadheeb NS, Chi A, et al.: Efficacy and safety of early dexmedetomidine during noninvasive ventilation for patients with acute respiratory failure: A randomized, double-blind, placebo-controlled pilot study. Chest 2014; 145:1204–1212
Desai RJ, Levin R, Lin KJ, et al.: Bias implications of outcome misclassification in observational studies evaluating association between treatments and all-cause or cardiovascular mortality using administrative claims. J Am Heart Assoc 2020; 9:e016906