Karim Habib Mr, Šarc Irena, Calandra Camilla, Spadaro Savino, Mina Bushra, Ciobanu Laura D, Gonçalves Gil, Caldeira Vania, Cabrita Bruno, Perren Andreas, Fiorentino Giuseppe, Utku Tughan, Piervincenzi Edoardo, El-Khatib Mohamad, Alpay Nilgün, Ferrari Rodolfo, Abdelrahim Mohamed Ea, Saeed Haitham, Madney Yasmin M, Harb Hadeer S, Vargas Nicola, Demirkiran Hilmi, Bhakta Pradipta, Papadakos Peter, Gómez-Ríos Manuel Á, Abad Alfredo, Alqahtani Jaber S, Hadda Vijay, Singha Subrata K, Esquinas Antonio M
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesiology and Intensive Care, University of Ferrara, Ferrara, Italy.
Indian J Crit Care Med. 2022 Aug;26(8):938-948. doi: 10.5005/jp-journals-10071-23950.
This systematic review aimed to investigate the drugs used and their potential effect on noninvasive ventilation (NIV).
NIV is used increasingly in acute respiratory failure (ARF). Sedation and analgesia are potentially beneficial in NIV, but they can have a deleterious impact. Proper guidelines to specifically address this issue and the recommendations for or against it are scarce in the literature. In the most recent guidelines published in 2017 by the European Respiratory Society/American Thoracic Society (ERS/ATS) relating to NIV use in patients having ARF, the well-defined recommendation on the selective use of sedation and analgesia is missing. Nevertheless, some national guidelines suggested using sedation for agitation.
Electronic databases (PubMed/Medline, Google Scholar, and Cochrane library) from January 1999 to December 2019 were searched systematically for research articles related to sedation and analgosedation in NIV. A brief review of the existing literature related to sedation and analgesia was also done.
Sixteen articles (five randomized trials) were analyzed. Other trials, guidelines, and reviews published over the last two decades were also discussed. The present review analysis suggests dexmedetomidine as the emerging sedative agent of choice based on the most recent trials because of better efficacy with an improved and predictable cardiorespiratory profile.
Current evidence suggests that sedation has a potentially beneficial role in patients at risk of NIV failure due to interface intolerance, anxiety, and pain. However, more randomized controlled trials are needed to comment on this issue and formulate strong evidence-based recommendations.
Karim HMR, Šarc I, Calandra C, Spadaro S, Mina B, Ciobanu LD, et al. Role of Sedation and Analgesia during Noninvasive Ventilation: Systematic Review of Recent Evidence and Recommendations. Indian J Crit Care Med 2022;26(8):938-948.
本系统评价旨在研究无创通气（NIV）中使用的药物及其潜在效果。
NIV在急性呼吸衰竭（ARF）中的应用日益广泛。镇静和镇痛在NIV中可能有益，但也可能产生有害影响。针对这一问题的具体指南以及支持或反对的建议在文献中较为匮乏。欧洲呼吸学会/美国胸科学会（ERS/ATS）于2017年发布的关于ARF患者使用NIV的最新指南中，缺少关于选择性使用镇静和镇痛的明确建议。尽管如此，一些国家指南建议对躁动患者使用镇静剂。
系统检索了1999年1月至2019年12月的电子数据库（PubMed/Medline、谷歌学术和考克兰图书馆），以查找与NIV中镇静和镇痛相关的研究文章。还对与镇静和镇痛相关的现有文献进行了简要综述。
分析了16篇文章（5项随机试验）。还讨论了过去二十年发表的其他试验、指南和综述。本综述分析表明，基于最新试验，右美托咪定因其疗效更好且心肺功能改善和可预测，成为新兴的首选镇静剂。
目前的证据表明，镇静在因面罩不耐受、焦虑和疼痛而有NIV失败风险的患者中可能具有潜在益处。然而，需要更多的随机对照试验来对这一问题进行评论并制定强有力的循证建议。
卡里姆HMR、萨尔奇I、卡兰德拉C、斯帕达罗S、米纳B、乔巴努LD等。无创通气期间镇静和镇痛的作用：近期证据和建议的系统评价。《印度重症监护医学杂志》2022年；26（8）：938 - 948。
