Medical Intensive Care Unit, Pellegrin Teaching Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France.
Intensive Care Med. 2010 Oct;36(10):1675-1680. doi: 10.1007/s00134-010-1904-7. Epub 2010 May 11.
Non-invasive ventilation (NIV) in critically ill patients is associated with a high failure rate. This prospective study assessed the feasibility and safety of target-controlled infusion (TCI) of propofol for conscious sedation during NIV in patients with NIV failure due to low tolerance.
Ten patients with NIV failure due to discomfort, agitation and/or refusal to continue with this ventilatory support were included; seven had acute respiratory failure and three had acute hypercapnic respiratory failure. Patients were sedated by TCI of propofol during NIV sessions. Blood gas analysis, cardiorespiratory and ventilatory parameters, propofol concentration (Cpt) required, comfort and adverse events were recorded.
Patients received a total of 85 NIV sessions, totalling 180 h of NIV under TCI of propofol (mean Cpt, 0.82 ± 0.25 μg/ml). NIV under TCI of propofol significantly improved arterial blood gas analyses: mean Pa/FiO(2) ratio increased from 167 ± 68 pre-session to 195 ± 68 post-session (p < 0.05), mean PaCO(2) decreased from 57.8 ± 15.3 to 49 ± 9.8 mmHg (p < 0.05) and mean pH increased from 7.36 ± 0.04 to 7.4 ± 0.03 (p < 0.05). Three patients required endotracheal intubation, two due to evolution of underlying disease and one because of a seizure disorder. Eight patients were discharged from the intensive care unit and two died.
This preliminary study shows that in a selected population, TCI of propofol can facilitate acceptance of NIV. Within the limits of a pilot study, TCI of propofol seems to be safe and effective for the treatment of NIV failure due to low tolerance.
在危重症患者中，无创通气（NIV）的失败率很高。本前瞻性研究评估了在因低耐受性而导致 NIV 失败的患者中，使用异丙酚靶控输注（TCI）进行镇静的可行性和安全性。
纳入了 10 例因不适、躁动和/或拒绝继续接受这种通气支持而导致 NIV 失败的患者；其中 7 例患有急性呼吸衰竭，3 例患有急性高碳酸血症性呼吸衰竭。患者在 NIV 期间通过 TCI 异丙酚进行镇静。记录血气分析、心肺和通气参数、所需异丙酚浓度（Cpt）、舒适度和不良事件。
患者共接受了 85 次 NIV 治疗，共接受了 180 小时 TCI 异丙酚下的 NIV（平均 Cpt 为 0.82±0.25μg/ml）。TCI 异丙酚下的 NIV 显著改善了动脉血气分析：平均 Pa/FiO（2）比值从治疗前的 167±68 增加到治疗后的 195±68（p<0.05），平均 PaCO（2）从 57.8±15.3 降低到 49±9.8mmHg（p<0.05），平均 pH 值从 7.36±0.04 增加到 7.4±0.03（p<0.05）。有 3 例患者需要气管插管，其中 2 例是由于基础疾病的进展，1 例是由于癫痫发作。8 例患者从重症监护病房出院，2 例死亡。
本初步研究表明，在选择的人群中，TCI 异丙酚可以促进对 NIV 的接受。在一项试点研究的范围内，TCI 异丙酚似乎是安全有效的，可用于治疗因低耐受性导致的 NIV 失败。
