Department of Anesthesiology and Intensive Care, University of Rome La Sapienza, Rome, Italy.
Intensive Care Med. 2010 Dec;36(12):2060-5. doi: 10.1007/s00134-010-2026-y. Epub 2010 Sep 17.
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.
Prospective uncontrolled clinical investigation in a 14-bed ICU of an university hospital in Italy.
Thirty-six patients with persistent severe HARF who complained of discomfort and asked for interruption of NPPV session.
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.
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).
This clinical study suggests that a remifentanil-based sedation protocol can decrease the rate of failure in patients with intolerance to NPPV.
评估在因不耐受两种不同接口（头盔和全面罩）而拒绝继续无创通气（NPPV）的低氧性急性呼吸衰竭（HARF）患者中，瑞芬太尼镇静的可行性。
在意大利一所大学医院的 14 张 ICU 病床的前瞻性非对照临床研究。
36 名持续存在严重 HARF 的患者抱怨不适，并要求中断 NPPV 治疗。
患者开始用瑞芬太尼（0.025μgkg(-1)min(-1)）镇静，输注率每分钟增加 0.01μgkg(-1)min(-1)，最高可达 0.12μgkg(-1)min(-1)，以获得患者舒适。
在引入瑞芬太尼输注后，36 名患者中有 22 名（61%）继续接受 NPPV 治疗，他们的中位数（IQR）SAPS II 评分为 32（30，38）。在成功组中，呼吸频率中位数（IQR）从 34（31，37）降至 24（20，26）min(-1)（p < 0.0001），PaO(2)/FiO(2) 比值从 156（144，176）mmHg 增加至 270（210，300）mmHg（p < 0.0001）在接受 NPPV 治疗 1 小时后，无论是使用头盔还是全面罩，患者均接受瑞芬太尼-阿片类药物镇静治疗。14 名患者未能继续无创治疗，在平均 2.5±2.3 小时后插管；他们的呼吸频率从 35（30，38）降至 27（25，35）min(-1)（p = 0.02），无法将 PaO(2)/FiO(2) 比值提高到 180mmHg 以上。失败组患者的 ICU 死亡率为 50%，而 NPPV 成功组为 14%（p < 0.05）。给予的瑞芬太尼平均剂量为 0.07±0.03μgkg(-1)min(-1)。
这项临床研究表明，瑞芬太尼镇静方案可以降低不耐受 NPPV 患者的治疗失败率。
