Acute Crit Care.  2020 Nov;35(4):255-262. 10.4266/acc.2020.00164.

Utilization of pain and sedation therapy on noninvasive mechanical ventilation in Korean intensive care units: a multi-center prospective observational study

Affiliations
  • 1Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
  • 2Department of Pulmonary and Critical Care Medicine, Inha University College of Medicine, Incheon, Korea
  • 3Department of Pulmonary and Critical Care Medicine, Yeungnam University Hospital, Daegu, Korea
  • 4Department of Pulmonary and Critical Care Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
  • 5Department of Internal Medicine, Myongji Hospital, Goyang, Korea
  • 6Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
  • 7Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon, Korea
  • 8Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
  • 9Department of Pulmonary, Critical Care and Sleep Medicine, St. Paul’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 10Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
  • 11Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
  • 12Department of Pulmonary, Allergy and Critical Care Medicine, Jeonbuk National University Hospital, Jeonju, Korea
  • 13Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
  • 14Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Abstract

Background
The use of sedative drugs may be an important therapeutic intervention during noninvasive ventilation (NIV) in intensive care units (ICUs). The purpose of this study was to assess the current application of analgosedation in NIV and its impact on clinical outcomes in Korean ICUs.
Methods
Twenty Korean ICUs participated in the study, and data was collected on NIV use during the period between June 2017 and February 2018. Demographic data from all adult patients, NIV clinical parameters, and hospital mortality were included.
Results
A total of 155 patients treated with NIV in the ICUs were included, of whom 26 received pain and sedation therapy (sedation group) and 129 did not (control group). The primary cause of ICU admission was due to acute exacerbation of obstructed lung disease (45.7%) in the control group and pneumonia treatment (53.8%) in the sedation group. In addition, causes of NIV application included acute hypercapnic respiratory failure in the control group (62.8%) and post-extubation respiratory failure in the sedation group (57.7%). Arterial partial pressure of carbon dioxide (PaCO2) levels before and after 2 hours of NIV treatment were significantly decreased in both groups: from 61.9±23.8 mm Hg to 54.9±17.6 mm Hg in the control group (P<0.001) and from 54.9±15.1 mm Hg to 51.1±15.1 mm Hg in the sedation group (P=0.048). No significant differences were observed in the success rate of NIV weaning, complications, length of ICU stay, ICU survival rate, or hospital survival rate between the groups.
Conclusions
In NIV patients, analgosedation therapy may have no harmful effects on complications, NIV weaning success, and mortality compared to the control group. Therefore, sedation during NIV may not be unsafe and can be used in patients for pain control when indicated.

Keyword

intensive care units; noninvasive ventilation; safety; sedatives
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