Habib Mr Karim, Irena Šarc, Camilla Calandra, Savino Spadaro, Bushra Mina, Laura D Ciobanu, Gil Gonçalves, Vania Caldeira, Bruno Cabrita, Andreas Perren, Giuseppe Fiorentino, Tughan Utku, Edoardo Piervincenzi, Mohamad El-Khatib, Nilgün Alpay, Rodolfo Ferrari, Mohamed Ea Abdelrahim, Haitham Saeed, Yasmin M Madney, Hadeer S Harb, Nicola Vargas, Hilmi Demirkiran, Pradipta Bhakta, Peter Papadakos, Manuel Á Gómez-Ríos, Alfredo Abad, Jaber S Alqahtani, Vijay Hadda, Subrata K Singha, Antonio M Esquinas
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引用次数: 5
摘要
目的:本系统综述旨在探讨所使用的药物及其对无创通气的潜在影响。背景:NIV在急性呼吸衰竭(ARF)中的应用越来越多。镇静和镇痛在NIV中可能是有益的，但它们可能有有害的影响。具体解决这一问题的适当指导方针以及支持或反对它的建议在文献中很少。在欧洲呼吸学会/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。然而，一些国家指南建议使用镇静剂来治疗躁动。方法:系统检索1999年1月至2019年12月电子数据库(PubMed/Medline、Google Scholar和Cochrane library)中与NIV镇静和镇痛相关的研究文章。简要回顾了有关镇静和镇痛的现有文献。回顾结果:16篇文章(5个随机试验)被分析。讨论了过去二十年中发表的其他试验、指南和评论。目前的综述分析表明，根据最近的试验，右美托咪定作为新兴的镇静剂的选择，因为它具有更好的疗效和改善的可预测的心肺功能。结论:目前的证据表明，镇静对因界面不耐受、焦虑和疼痛而有NIV失败风险的患者具有潜在的有益作用。然而，需要更多的随机对照试验来评论这一问题并制定强有力的循证建议。本文引用方式:Karim HMR， Šarc I, Calandra C, Spadaro S, Mina B, Ciobanu LD等。镇静和镇痛在无创通气中的作用:近期证据和建议的系统回顾。中华检验医学杂志;2009;26(8):938-948。
Role of Sedation and Analgesia during Noninvasive Ventilation: Systematic Review of Recent Evidence and Recommendations.
Aim: This systematic review aimed to investigate the drugs used and their potential effect on noninvasive ventilation (NIV).
Background: 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.
Methods: 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.
Review results: 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.
Conclusion: 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.
How to cite this article: 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.
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