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Analgesia and Sedation Use During Noninvasive Ventilation for Acute Respiratory Failure
Journal article   Peer reviewed

Analgesia and Sedation Use During Noninvasive Ventilation for Acute Respiratory Failure

Peter J Dunbar, Ryan Peterson, Max McGrath, Raymond Pomponio, Tyree H Kiser, P Michael Ho, R William Vandivier, Ellen L Burnham, Marc Moss, Peter D Sottile, …
Critical care medicine, Vol.52(7), pp.1043-1053
07/01/2024
DOI: 10.1097/CCM.0000000000006253
PMCID: PMC13107206
PMID: 38506571

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Abstract

To describe U.S. practice regarding administration of sedation and analgesia to patients on noninvasive ventilation (NIV) for acute respiratory failure (ARF) and to determine the association of this practice with odds of intubation or death. A retrospective multicenter cohort study. A total of 1017 hospitals contributed data between January 2010 and September 2020 to the Premier Healthcare Database, a nationally representative healthcare database in the United States. Adult (≥ 18 yr) patients admitted to U.S. hospitals requiring NIV for ARF. None. We identified 433,357 patients on NIV of whom (26.7% [95% CI] 26.3%-27.0%) received sedation or analgesia. A total of 50,589 patients (11.7%) received opioids only, 40,646 (9.4%) received benzodiazepines only, 20,146 (4.6%) received opioids and benzodiazepines, 1.573 (0.4%) received dexmedetomidine only, and 2,639 (0.6%) received dexmedetomidine in addition to opioid and/or benzodiazepine. Of 433,357 patients receiving NIV, 50,413 (11.6%; 95% CI, 11.5-11.7%) patients underwent invasive mechanical ventilation on hospital days 2-5 or died on hospital days 2-30. Intubation was used in 32,301 patients (7.4%; 95% CI, 7.3-7.6%). Further, death occurred in 24,140 (5.6%; 95% CI, 5.5-5.7%). In multivariable analysis adjusting for relevant covariates, receipt of any medication studied was associated with increased odds of intubation or death. In inverse probability weighting, receipt of any study medication was also associated with increased odds of intubation or death (average treatment effect odds ratio 1.38; 95% CI, 1.35-1.40). The use of sedation and analgesia during NIV is common. Medication exposure was associated with increased odds of intubation or death. Further investigation is needed to confirm this finding and determine whether any subpopulations are especially harmed by this practice.
 United States Adult Aged Analgesia - methods Analgesia - statistics & numerical data Analgesics, Opioid - administration & dosage Analgesics, Opioid - therapeutic use Benzodiazepines - administration & dosage Benzodiazepines - therapeutic use Female Humans Hypnotics and Sedatives - administration & dosage Hypnotics and Sedatives - therapeutic use Male Middle Aged Noninvasive Ventilation - methods Respiratory Distress Syndrome - mortality Respiratory Distress Syndrome - therapy Respiratory Insufficiency - mortality Respiratory Insufficiency - therapy Retrospective Studies

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