Division of Medical Intensive Care, University Hospital, Bordeaux, France.
Minerva Anestesiol. 2012 Jul;78(7):842-6. Epub 2012 May 11.
Non-invasive ventilation (NIV) is increasingly used in patients with acute respiratory failure, but few data exist regarding current sedation practices during NIV. Mask intolerance or claustrophobia, and delirium and agitation, may lead to NIV failure, requiring endotracheal intubation. Judicious use of sedation during NIV could be one of the valuable options for some of these patients at risk of intubation. Although different sedatives have been used in published studies, the objectives of sedation are similar: allowing mitigation of patient discomfort and obtaining the desired level of sedation. Whatever the sedative used, the goal is to achieve sedation to a point where the patients are awake and arousable and comfortable. Pilot studies suggest that continuous infusion of a single sedative agent may decrease patient discomfort, with no significant effects on respiratory drive, respiratory pattern, or hemodynamics. In addition, gas exchange improved under NIV with sedation. While the current limited data available suggests that sedation during NIV is safe and feasible, more widespread application should await the results of randomized clinical trials.
无创通气（NIV）在急性呼吸衰竭患者中的应用日益增多，但关于 NIV 期间镇静治疗的现有数据较少。面罩不耐受或幽闭恐惧症、谵妄和激越可能导致 NIV 失败，需要气管插管。在这些有插管风险的患者中，明智地使用镇静治疗可能是有价值的选择之一。尽管在已发表的研究中使用了不同的镇静剂，但镇静的目的是相似的：减轻患者的不适并获得所需的镇静水平。无论使用何种镇静剂，目标都是使患者达到清醒、可唤醒和舒适的镇静程度。初步研究表明，单一镇静剂的持续输注可能会减轻患者的不适，而对呼吸驱动、呼吸模式或血流动力学没有显著影响。此外，NIV 下的通气改善。虽然目前可用的有限数据表明，NIV 期间的镇静是安全可行的，但更广泛的应用应等待随机临床试验的结果。
