Impact of sedation and analgesia during noninvasive positive pressure ventilation on outcome: a marginal structural model causal analysis

Alfonso Muriel, Oscar Penuelas, Fernando Frutos-Vivar, Alejandro C Arroliga, Victor Abraira, Arnaud W Thille, Laurent Brochard, Nicolas Nin, Andrew Ross Davies, Pravin Amin, Bin Du, Konstantinos Raymondos, Fernando Rios, Damian A Violi, Salvatore Maggiore, Marco Antonio Soares, Marco Gonzalez, Fekri Abroug, Hans-Henrik Bulow, Francisco Javier HurtadoMichael A Kuiper, Rui Paulo Moreno, Amine Ali Zeggwagh, Asisclo Villagomez, Manuel Jibaja, Luis Soto, Gabriel D'Empaire, Dimitrios Matamis, Younsuck Koh, Antonio Anzueto, Niall Ferguson, Andres Esteban

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Abstract

Purpose: There are limited data available about the role of sedation and analgesia during noninvasive positive pressure ventilation (NPPV). The objective of study was to estimate the effect of analgesic or sedative drugs on the failure of NPPV. Methods: We studied patients who received at least 2 h of NPPV as first-line therapy in a prospective observational study carried out in 322 intensive care units from 30 countries. A marginal structural model (MSM) was used to analyze the association between the use of analgesic or sedative drugs and NPPV failure (defined as need for invasive mechanical ventilation). Results: 842 patients were included in the analysis. Of these, 165 patients (19.6 ) received analgesic or sedative drugs at some time during NPPV; 33 of them received both. In the adjusted analysis, the use of analgesics (odds ratio 1.8, 95 confidence interval 0.6?5.4) or sedatives (odds ratio 2.8, 95 CI 0.85?9.4) alone was not associated with NPPV failure, but their combined use was associated with failure (odds ratio 5.7, 95 CI 1.8?18.4). Conclusions: Slightly less than 20 of patients received analgesic or sedative drugs during NPPV, with no apparent effect on outcome when used alone. However, the simultaneous use of analgesics and sedatives may be associated with failure of NPPV.
Original languageEnglish
Pages (from-to)1586 - 1600
Number of pages15
JournalIntensive Care Medicine
Volume41
Issue number9
DOIs
Publication statusPublished - 2015

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