Abstract:
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 < 0.0001) and PaO(2)/FiO(2) ratio increased from 156 (144, 176) to 270 (210, 300) mmHg (p < 0.0001) after 1 h of NPPV with remifentanil-analgosedation either with helmet or total face mask. Fourteen patients failed to continue the noninvasive treatment and were intubated after a mean of 2.5 ± 2.3 h; they showed a respiratory rate decrease from 35 (30, 38) to 27 (25, 35) min(-1) (p = 0.02) and an inability to increase the PaO(2)/FiO(2) ratio above 180 mmHg. The ICU mortality in the failure group patients was 50 versus 14% in the NPPV success group (p < 0.05). The mean remifentanil dose administered was 0.07 ± 0.03 μg kg(-1) min(-1). CONCLUSION:This clinical study suggests that a remifentanil-based sedation protocol can decrease the rate of failure in patients with intolerance to NPPV.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Rocco M,Conti G,Alessandri E,Morelli A,Spadetta G,Laderchi A,Di Santo C,Francavilla S,Pietropaoli Pdoi
10.1007/s00134-010-2026-ysubject
Has Abstractpub_date
2010-12-01 00:00:00pages
2060-5issue
12eissn
0342-4642issn
1432-1238journal_volume
36pub_type
临床试验,杂志文章abstract:OBJECTIVE:This study compared the recently introduced Microcuff endotracheal tube HVLP ICU featuring an ultrathin (7-microm) polyurethane cuff membrane with endotracheal tubes from different manufacturers regarding fluid leakage past the tube cuff. DESIGN:In vitro setup. MEASUREMENTS AND RESULTS:The following endotra...
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journal_title:Intensive care medicine
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doi:10.1007/s00134-007-0601-7
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更新日期:2015-08-01 00:00:00
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更新日期:2005-03-01 00:00:00
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更新日期:2011-05-01 00:00:00
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更新日期:2017-03-01 00:00:00
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更新日期:1998-08-01 00:00:00