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

Acute and Critical Care 2020년 35권 4호 p.255 ~ 262
김태희, 김정수, 최은영, 장유진, 최원일, 황재준, 문재영, 이광하, 김세원, 강형구, 심윤수, 박태선, 박승용, 박성훈, 조재화,
소속 상세정보
김태희 ( Kim Tae-Hee ) - Hallym University Kangnam Sacred Heart Hospital Department of Pulmonary, Allergy and Critical Care Medicine
김정수 ( Kim Jung-Soo ) - Inha University College of Medicine Department of Pulmonary and Critical Care Medicine
최은영 ( Choi Eun-Young ) - Yeungnam University Hospital Department of Pulmonary and Critical Care Medicine
장유진 ( Chang You-Jin ) - Inje University Sanggye Paik Hospital Department of Pulmonary and Critical Care Medicine
최원일 ( Choi Won-Il ) - Myongji Hospital Department of Internal Medicine
황재준 ( Hwang Jae-Joon ) - Kyung Hee University Hospital at Gangdong Department of Pulmonary and Critical Care Medicine
문재영 ( Moon Jae-Young ) - Chungnam National University Hospital Department of Pulmonary and Critical Care Medicine
이광하 ( Lee Kwang-Ha ) - Pusan National University Hospital Department of Internal Medicine
김세원 ( Kim Sei-Won ) - Catholic University College of Medicine St. Paul’s Hospital Department of Pulmonary, Critical Care and Sleep Medicine
강형구 ( Kang Hyung-Koo ) - Inje University Ilsan Paik Hospital Department of Internal Medicine
심윤수 ( Sim Yun-Su ) - Hallym University Kangnam Sacred Heart Hospital Department of Pulmonary, Allergy and Critical Care Medicine
박태선 ( Park Tai-Sun ) - Hanyang University Guri Hospital Department of Internal Medicine
박승용 ( Park Seung-Yong ) - Jeonbuk National University Hospital Department of Pulmonary, Allergy and Critical Care Medicine
박성훈 ( Park Sung-Hoon ) - Hallym University Sacred Heart Hospital Department of Pulmonary, Allergy and Critical Care Medicine
조재화 ( Cho Jae-Hwa ) - Yonsei University College of Medicine Gangnam Severance Hospital Department of Internal Medicine

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.

키워드

intensive care units; noninvasive ventilation; safety; sedatives

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