Dexmedetomidine for sedation during nonivasive ventilation in acute respiratory syndrome patients

Noninvasive ventilation (NIV) is commonly used to prevent endotracheal intubation in patients with mild to moderate acute respiratory distress syndrome (ARDS). Dexmedetomidine (DEX) provide cooperative sedation, and could be beneficial for patients with ARDS receiving NIV. Aim of this study was to compare DEX with placebo for sedation during NIV.Adults with ARDS due to community aquired pneumonia with PaO2/FiO2 ratio 150-300 mmHg were randomly allocated to receive IV dexmedetomidine (0.2 μg/kg/h titrated every 30 min to 0.7 μg/kg/h to maintain a Richmond sedation agitation score (RASS) of 0 to -2) or placebo up to 72 h, until NIV was stopped for ≥ 2 h, or until intubation. Data are presented as median and 25-75 quartiles. Nonparametric criteria were used for data analysis.DEX (n=15) and placebo (n=14) group did not differ at baseline. DEX was associated with significatly higher patient comfort (7 [6-9] vs 5 [3-7] by 10-points scale); goal level of sedation was achieved during 86 [78-92]% of total sedation time in group D, and in 63 [49-72]% of time in group P (p<0.05). DEX was associated with significantly lower incidence of delirium (1/15 vs 6/14 in placebo group, p=0.03) and lower incidence of posttraumatic stress disorder after ICU discharge (1/8 vs 4/9 in placebo group, p=0.9). The incidence of complications varied between groups: arterial hypotension occurred in 3/15 (20%) patients in group D and in 1/14 (7%) patients in group P (p>0.05), bradycardia in 7/...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Noninvasive Ventilatory Support Source Type: research