Application of goal directed analgesia in noninvasive positive pressure ventilation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

DOU Zhimin , LI Fenjiao , CHEN Qiming ,  LI Bin , LIU Jian

Department of Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P. R. China.;

Corresponding author：

LI Bin, Email: lynd001@163.com

Keywords：

Analgesia; Noninvasive positive pressure ventilation; Critical Care Pain Observation Tool

DOI：

10.7507/1671-6205.201809055

Video：

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Objective To explore the effect of goal directed analgesia on patients with noninvasive positive pressure ventilation (NPPV) in the intensive care unit (ICU).Methods This was a retrospective study. Two hundred sixty-four patients requiring non-invasive positive pressure ventilation were enrolled in the ICU of this hospital, including 118 patients in the empirical analgesia group and 146 in the goal directed analgesia group. The empirical analgesia group was treated with remifentanil to analgesia and propofol, midazolam or dexmedetomidine to sedation. The sedative depth maintained <1 measured by the score of the Richmond restless sedative scale (RASS). The same analgesic and sedative drug were first used in the goal directed analgesia group to maintain the Critical Care Pain Observation Tool score <2, and the RASS score <1 was maintained after the analgesia depth were achieved. Whether the patients occurred delirium was assessed by the Confusion Assessment Method for the ICU. The dosage of analgesic and sedative drugs, the dependability (based on the total ventilation time in the first 24 hours after ventilation), the incidence of delirium, the rate of invasive ventilation, the total time of NPPV and the length of stay of ICU were observed in the two groups.Results There were no significant differences in age, sex, APACHEⅡ score, mean arterial pressure, heart rate, respiratory rate, SpO₂, arterial blood gas and the reason of NPPV between the two groups. The dosage of analgesic and sedative drugs in the goal directed analgesia group were less than the empirical analgesia group, and the dependability was higher than that of the empirical analgesia group ［(12.6±5.8)h vs. (10.9±4.8)h, P<0.05), and the incidence of delirium and the rate of invasive ventilation were also lower than those of the empirical analgesia group (15.8% vs. 25.4%, P<0.05; 32.9% vs. 44.9%, P<0.05). The total time of NPPV in the goal directed analgesia group was shorter than that of the empirical analgesia group ［(28.6±8.8)h vs. (37.3±10.7)h, P<0.05), but there was no significant difference in the length of stay in ICU.Conclusion Goal directed analgesia can improve the dependability of NPPV patients, reduce the use of sedative drugs, and decrease the incidence of delirium and rate of invasive ventilation.

Citation： DOU Zhimin, LI Fenjiao, CHEN Qiming, LI Bin, LIU Jian. Application of goal directed analgesia in noninvasive positive pressure ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(5): 457-460. doi: 10.7507/1671-6205.201809055 Copy

1.	Thille AW, Frat JP. Noninvasive ventilation as acute therapy. Curr Opin Crit Care, 2018, 24(6): 519-524.
2.	Bellani G, Laffey JG, Pham T, et al. Noninvasive ventilation of patients with acute respiratory distress syndrome. Insights from the LUNG SAFE Study. Am J Respir Crit Care Med, 2017, 195(1): 67-77.
3.	Gonzalez-Bermejo J, Janssens JP, Rabec C, et al. Framework for patient-ventilator asynchrony during long-term non-invasive ventilation. Thorax, 2019, 74(7): 715-717.
4.	Vignaux L, Vargas F, Roeseler J, et al. Patient-ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study. Intensive Care Med, 2009, 35(5): 840-846.
5.	Hilbert G, Navalesi P, Girault C. Is sedation safe and beneficial in patients receiving NIV? Yes. Intensive Care Med, 2015, 41(9): 1688-1691.
6.	Muriel A, Peñuelas O, Frutos-Vivar F, et al. Impact of sedation and analgesia during noninvasive positive pressure ventilation on outcome: a marginal structural model causal analysis. Intensive Care Med, 2015, 41(9): 1586-1600.
7.	Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain agitation and delirium in adult patients in the intensive care unit. Crit Care Med, 2013, 41(1): 263-306.
8.	陈启江, 施宗驱, 薛其骏, 等. 右美托咪定在慢性阻塞性肺疾病急性加重合并呼吸衰竭患者无创通气中的应用. 中国呼吸与危重监护杂志, 2013, 12(1): 29-31.
9.	Cheng X. Noninvasive ventilation in acute respiratory failure: who will benefit?. Crit Care Med, 2018, 46(2): e184-e185.
10.	Peñuelas Ó, Esteban A. Noninvasive ventilation for acute respiratory failure: the next step is to know when to stop. Eur Respir J, 2018, 52(2): 1801185.
11.	Owen GD, Stollings JL, Rakhit S, et al. International Analgesia, Sedation, and Delirium Practices: a prospective cohort study. J Intensive Care, 2019, 7: 25.
12.	Payen JF, Bosson JL, Chanques G, et al. Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit: a post Hoc analysis of the DOLOREA study. Anesthesiology, 2009, 111(6): 1308-1316.
13.	Vincent JL, Shehabi Y, Walsh TS, et al. Comfort and patient-centred care without excessive sedation: the eCASH concept. Intensive Care Med, 2016, 42(6): 962-971.
14.	Fanelli G, Barbagallo M, Tagliaferri F. Monitoring pain-sedation-delirium in ICU: the Cinderella of analgo-sedation strategy?. Minerva Anestesiol, 2017, 83(2): 131-133.
15.	Arias-Rivera S, Sánchez-Sánchez MM, Santos-Díaz R, et al. Effect of a nursing-implemented sedation protocol on weaning outcome. Crit Care Med, 2008, 36(7): 2054-2060.
16.	Georgiou E, Hadjibalassi M, Lambrinou E, et al. The impact of pain assessment on critically ill patients' outcomes: a systematic review. Biomed Res Int, 2015, 2015: 503830.
17.	Faust AC, Rajan P, Sheperd LA, et al. Impact of an analgesia-based sedation protocol on mechanically ventilated patients in a medical intensive care unit. Anesth Analg, 2016, 123(4): 903-909.

1. Thille AW, Frat JP. Noninvasive ventilation as acute therapy. Curr Opin Crit Care, 2018, 24(6): 519-524.
2. Bellani G, Laffey JG, Pham T, et al. Noninvasive ventilation of patients with acute respiratory distress syndrome. Insights from the LUNG SAFE Study. Am J Respir Crit Care Med, 2017, 195(1): 67-77.
3. Gonzalez-Bermejo J, Janssens JP, Rabec C, et al. Framework for patient-ventilator asynchrony during long-term non-invasive ventilation. Thorax, 2019, 74(7): 715-717.
4. Vignaux L, Vargas F, Roeseler J, et al. Patient-ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study. Intensive Care Med, 2009, 35(5): 840-846.
5. Hilbert G, Navalesi P, Girault C. Is sedation safe and beneficial in patients receiving NIV? Yes. Intensive Care Med, 2015, 41(9): 1688-1691.
6. Muriel A, Peñuelas O, Frutos-Vivar F, et al. Impact of sedation and analgesia during noninvasive positive pressure ventilation on outcome: a marginal structural model causal analysis. Intensive Care Med, 2015, 41(9): 1586-1600.
7. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain agitation and delirium in adult patients in the intensive care unit. Crit Care Med, 2013, 41(1): 263-306.
8. 陈启江, 施宗驱, 薛其骏, 等. 右美托咪定在慢性阻塞性肺疾病急性加重合并呼吸衰竭患者无创通气中的应用. 中国呼吸与危重监护杂志, 2013, 12(1): 29-31.
9. Cheng X. Noninvasive ventilation in acute respiratory failure: who will benefit?. Crit Care Med, 2018, 46(2): e184-e185.
10. Peñuelas Ó, Esteban A. Noninvasive ventilation for acute respiratory failure: the next step is to know when to stop. Eur Respir J, 2018, 52(2): 1801185.
11. Owen GD, Stollings JL, Rakhit S, et al. International Analgesia, Sedation, and Delirium Practices: a prospective cohort study. J Intensive Care, 2019, 7: 25.
12. Payen JF, Bosson JL, Chanques G, et al. Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit: a post Hoc analysis of the DOLOREA study. Anesthesiology, 2009, 111(6): 1308-1316.
13. Vincent JL, Shehabi Y, Walsh TS, et al. Comfort and patient-centred care without excessive sedation: the eCASH concept. Intensive Care Med, 2016, 42(6): 962-971.
14. Fanelli G, Barbagallo M, Tagliaferri F. Monitoring pain-sedation-delirium in ICU: the Cinderella of analgo-sedation strategy?. Minerva Anestesiol, 2017, 83(2): 131-133.
15. Arias-Rivera S, Sánchez-Sánchez MM, Santos-Díaz R, et al. Effect of a nursing-implemented sedation protocol on weaning outcome. Crit Care Med, 2008, 36(7): 2054-2060.
16. Georgiou E, Hadjibalassi M, Lambrinou E, et al. The impact of pain assessment on critically ill patients' outcomes: a systematic review. Biomed Res Int, 2015, 2015: 503830.
17. Faust AC, Rajan P, Sheperd LA, et al. Impact of an analgesia-based sedation protocol on mechanically ventilated patients in a medical intensive care unit. Anesth Analg, 2016, 123(4): 903-909.

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Application of goal directed analgesia in noninvasive positive pressure ventilation

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