TY - JOUR
T1 - Impact of sedation and analgesia during noninvasive positive pressure ventilation on outcome
T2 - a marginal structural model causal analysis
AU - Muriel, Alfonso
AU - Peñuelas, Oscar
AU - Frutos-Vivar, Fernando
AU - Arroliga, Alejandro C.
AU - Abraira, Victor
AU - Thille, Arnaud W.
AU - Brochard, Laurent
AU - Nin, Nicolás
AU - Davies, Andrew R.
AU - Amin, Pravin
AU - Du, Bin
AU - Raymondos, Konstantinos
AU - Rios, Fernando
AU - Violi, Damian A.
AU - Maggiore, Salvatore M.
AU - Soares, Marco Antonio
AU - González, Marco
AU - Abroug, Fekri
AU - Bülow, Hans Henrik
AU - Hurtado, Javier
AU - Kuiper, Michael A.
AU - Moreno, Rui P.
AU - Zeggwagh, Amine Ali
AU - Villagómez, Asisclo J.
AU - Jibaja, Manuel
AU - Soto, Luis
AU - D’Empaire, Gabriel
AU - Matamis, Dimitrios
AU - Koh, Younsuck
AU - Anzueto, Antonio
AU - Ferguson, Niall D.
AU - Esteban, Andrés
N1 - Publisher Copyright:
© 2015, Springer-Verlag Berlin Heidelberg and ESICM.
PY - 2015/9/29
Y1 - 2015/9/29
N2 - 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.
AB - 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.
KW - Acute respiratory failure
KW - Analgesia
KW - Mortality
KW - Noninvasive positive pressure ventilation
KW - Sedation
UR - https://www.scopus.com/pages/publications/84940448797
U2 - 10.1007/s00134-015-3854-6
DO - 10.1007/s00134-015-3854-6
M3 - Artículo
C2 - 25971392
AN - SCOPUS:84940448797
SN - 0342-4642
VL - 41
SP - 1586
EP - 1600
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 9
ER -