The Efficacy of Dexmedetomidine in Patients with Noninvasive Ventilation: A Preliminary Study

Akada, Shinji; Takeda, Satoru; Yoshida, Yasuhiko; Nakazato, Keiko; Mori, Masaki; Hongo, Takashi; Tanaka, Keiji; Sakamoto, Atsuhiro

doi:10.1213/ane.0b013e3181732dc2

Cited by 89 publications

(62 citation statements)

References 13 publications

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“…Among the agents most frequently used were benzodiazepines. In 2008, Akada et al 15 reported a preliminary study that successfully used dexmedetomidine in 10 patients to facilitate NIV tolerance. Takasaki et al 16 reported the successful treatment of 2 severe asthmatic patients with the use of dexmedetomidine to facilitate NIV.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Ventilation in Severe Acute Asthma

Cappiello

Hocker

2014

Respir Care

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Noninvasive ventilation (NIV) in severe acute asthma is controversial but may benefit this population by preventing intubation. We report on a 35-year-old male asthma patient who presented to our emergency department via emergency medical services. The patient was responsive, diaphoretic, and breathing at 35 breaths/min on 100% oxygen with bag-mask assistance, with S pO 2 88%, heart rate 110 -120 beats/min, blood pressure 220/110 mm Hg, and temperature 35.8°C. NIV at 12/5 cm H 2 O and F IO 2 0.40 was applied, and albuterol at 40 mg/h was initiated. Admission arterial blood gas revealed a pH of 6.95, P aCO 2 126 mm Hg, and P aO 2 316 mm Hg. After 90 min of therapy, P aCO 2 was 63 mm Hg. Improvement continued, and NIV was stopped 4 h following presentation. NIV tolerance was supported with low doses of lorazepam. The patient was transferred to the ICU, moved to general care the next morning, and discharged 3 days later. We attribute our success to close monitoring in a critical care setting and the titration of lorazepam.

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Section: Discussionmentioning

confidence: 99%

Noninvasive Ventilation in Severe Acute Asthma

Cappiello

Hocker

2014

Respir Care

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“…Taken together, the results of these studies are encouraging [7][8][9][10][11][12][13]. Overall, the use of sedation during NIV appears feasible and safe.…”

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confidence: 96%

“…In addition to the present trial [5], several observational studies [7][8][9][10][11] and three randomized trials comparing midazolam and dexmedetomidine or placebo [12][13][14] have assessed the potential use of sedative and/or analgesic drugs to reduce discomfort and risk of NIV failure. The main characteristics and results of these studies are Table 1.…”

mentioning

confidence: 99%

“…Whatever the drugs used, the goal was to achieve a level of sedation to a point where patients were awake, arousable, and comfortable. Pilot studies have suggested that continuous infusion of a single sedative agent may decrease patient discomfort, with no significant deleterious effects on respiratory drive, respiratory pattern or hemodynamics, and with improvement in gas exchanges [7][8][9][10][11].…”

mentioning

confidence: 99%

“…Overall, the use of sedation during NIV appears feasible and safe. The ''curative'' use of sedation-analgesia, i.e., applied for treating discomfort leading to NIV intolerance, seems to be able to avoid intubation in 55-70 % of cases [8][9][10][11][12][13], while ensuring the desired level of awake sedation. By contrast, the ''preventive'' administration of sedation-analgesia, i.e., at initiation of NIV to prevent discomfort leading to intolerance, has so far not shown encouraging results [14].…”

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confidence: 99%

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