Comparison of clinical safety and efficacy of dexmedetomidine, remifentanil, and propofol in patients who cannot tolerate non-invasive mechanical ventilation: A prospective, randomized, cohort study

Abstract

Background and objectivesNon-invasive ventilation (NIV) is used in intensive care units (ICUs) to treat of respiratory failure. Sedation and analgesia are effective and safe for improving compliance in patients intolerant to NIV. Our study aimed to evaluate the effects of dexmedetomidine, remifentanil, and propofol on the clinical outcomes in NIV intolerant patients.MethodsThis prospective randomized cohort study was conducted in a tertiary ICU, between December 2018 and December 2019. We divided a total of 120 patients into five groups (DEXL, DEXH, REML, REMH, PRO). IBM SPSS Statistics 20 (IBM Corporation, Armonk, New York, USA) was used to conduct the statistical analyses.ResultsThe DEXL, DEXH, REML, and REMH groups consisted of 23 patients each while the PRO group consisted of 28 patients. Seventy-five patients (62.5%) became tolerant of NIV after starting the drugs. The NIV time, IMV time, ICU LOS, hospital LOS, intubation rate, side effects, and mortality were significantly different among the five groups (P = 0.05). In the groups that were given dexmedetomidine (DEXL, and DEXH), NIV failure, mortality, ICU LOS, and hospital LOS were lower than in the other groups.ConclusionIn this prospective study, we compared the results of three drugs (propofol, dexmedetomidine, and remifentanil) in patients with NIV intolerance. The use of sedation increased NIV success in patients with NIV intolerance. NIV failure, mortality, ICU LOS, IMV time, and hospital LOS were found to be lower with dexmedetomidine.

The effect of listening to music during continuous positive airway pressure on agitation levels and compliance of intensive care patients with COVID‐19: A randomized controlled trial

“…2 When patients receiving CPAP support cannot comply with the treatment, either CPAP therapy is terminated and other options are considered, or sedation is administered to these patients. 7 Therefore, the nursing care of the patient receiving CPAP therapy should aim to facilitate the patient's relaxation and compliance with CPAP. Music therapy, which is included in the Nursing Interventions Classification (NIC) with the code 4400, has been found to have pain, anxiety and stress-reducing effects, affect the patient's blood pressure, pulse, respiratory rate and oxygen saturation values, enable relaxation and increase patient comfort.…”

“…The panic caused by the patient's feeling of suffocation stimulates the sympathetic nervous system, increasing blood pressure, pulse rate and respiratory rate 2 . When patients receiving CPAP support cannot comply with the treatment, either CPAP therapy is terminated and other options are considered, or sedation is administered to these patients 7 . Therefore, the nursing care of the patient receiving CPAP therapy should aim to facilitate the patient's relaxation and compliance with CPAP.…”