Chest
Original ResearchEfficacy and Safety of Early Dexmedetomidine During Noninvasive Ventilation for Patients With Acute Respiratory Failure: A Randomized, Double-Blind, Placebo-Controlled Pilot Study
Section snippets
Setting
This prospective, randomized, double-blind, placebo-controlled study was conducted at two medical centers: Tufts Medical Center, a 320-bed academic medical center in Boston, Massachusetts, and Winchester Hospital, a 200-bed community hospital in Winchester, Massachusetts. The institutional review boards at each institution approved the study (IRB #8533 and IRB #5-2008, respectively), and written informed consent was obtained from all patients prior to randomization.
Patients
From September 2008 to
Results
Sixty-one patients were evaluated for participation in the study; 25 were excluded, and 36 were randomized (Fig 1). Three patients were withdrawn from the study before dexmedetomidine (or placebo) could be administered because of consent withdrawal (n = 1), emergent intubation (n = 1), and the accidental administration of nonblinded, nonstudy dexmedetomidine (n = 1). Thirty-three patients were, therefore, included in the final intention-to-treat analysis.
Baseline characteristics were similar
Discussion
Unlike other reports that have focused solely on either evaluating the role of dexmedetomidine as treatment of acute agitation during NIV23‐26 or in patients refusing to continue NIV,27 the present randomized, double-blind study sought to determine whether the routine early initiation of dexmedetomidine after the application of NIV would improve NIV tolerance. In a population of patients of which only one-third was intolerant of NIV at baseline, we found that the addition of low-dose IV
Acknowledgments
Author contributions: Dr Devlin had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Devlin: contributed to the study concept, data acquisition and interpretation, and manuscript preparation and final approval.
Dr Al-Qadheeb: contributed to the data acquisition and interpretation and manuscript preparation and final approval.
Dr Chi: contributed to the data acquisition and interpretation and manuscript
References (40)
- et al.
Utilization of noninvasive ventilation in acute care hospitals: a regional survey
Chest
(2006) - et al.
Complications of non-invasive ventilation techniques: a comprehensive qualitative review of randomized trials
Br J Anaesth
(2013) - et al.
Pharmacology of commonly used analgesics and sedatives in the ICU: benzodiazepines, propofol, and opioids
Anesthesiol Clin
(2011) - et al.
Sedation during noninvasive mechanical ventilation with dexmedetomidine or midazolam: a randomized. double-blind, prospective study
Curr Ther Res Clin Exp
(2010) - et al.
Review of pain-measurement tools
Ann Emerg Med
(1996) - et al.
The measurement of clinical pain intensity: a comparison of six methods
Pain
(1986) - et al.
Use of noninvasive ventilation in patients with acute respiratory failure, 2000-2009: a population-based study
Ann Am Thorac Soc
(2013) Complications of translaryngeal intubation
(1994)- et al.
Extended utilization of noninvasive ventilation for acute respiratory failure and its clinical outcomes
Respir Care
(2013) - et al.
Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study
Intensive Care Med
(2001)
Noninvasive ventilation: practical advice
Curr Opin Crit Care
Noninvasive ventilation in acute respiratory failure
Crit Care Med
Patient-ventilator interaction during noninvasive ventilation
Respir Care
Target-controlled infusion of propofol for sedation in patients with non-invasive ventilation failure due to low tolerance: a preliminary study
Intensive Care Med
Rescue treatment for noninvasive ventilation failure due to interface intolerance with remifentanil analgosedation: a pilot study
Intensive Care Med
Sedation during non-invasive ventilation
Minerva Anestesiol
Survey of sedation practices during noninvasive positive-pressure ventilation to treat acute respiratory failure
Crit Care Med
Adverse drug events associated with the use of analgesics, sedatives, and antipsychotics in the intensive care unit
Crit Care Med
Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit
Crit Care Med
Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients
Anesthesiology
Cited by (0)
Part of this article has been presented in abstract form at the American Thoracic Society International Conference, May 17-22, 2013, Philadelphia, PA.
Funding/Support: This study was supported by an unrestricted investigator-initiated grant from Hospira, Inc.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.