Remifentanil versus dexmedetomidine for treatment of cardiac surgery patients with moderate to severe noninvasive ventilation intolerance (REDNIVIN): a prospective, cohort study

Guang-Wei Hao, Jing-Chao Luo, Yan Xue, Guo-Guang Ma, Ying Su, Jun-Yi Hou, Shen-Ji Yu, Kai Liu, Ji-Li Zheng, Guo-Wei Tu, Zhe Luo, Guang-Wei Hao, Jing-Chao Luo, Yan Xue, Guo-Guang Ma, Ying Su, Jun-Yi Hou, Shen-Ji Yu, Kai Liu, Ji-Li Zheng, Guo-Wei Tu, Zhe Luo

Abstract

Background: The use of sedation to noninvasive ventilation (NIV) patients remains controversial, however, for intolerant patients who are uncooperative, administration of analgesics and sedatives may be beneficial before resorting to intubation. The aim of this study was to evaluate the efficacy of remifentanil (REM) versus dexmedetomidine (DEX) for treatment of cardiac surgery (CS) patients with moderate to severe NIV intolerance.

Methods: This prospective cohort study of CS patients with moderate to severe NIV intolerance was conducted between January 2018 and March 2019. Patients were treated with either REM or DEX, decided by the bedside intensivist. Depending on the treatment regimen, the patients were allocated to one of two groups: the REM group or DEX group.

Results: A total of 90 patients were enrolled in this study (52 in the REM group and 38 in the DEX group). The mitigation rate, defined as the percentage of patients who were relieved from the initial moderate to severe intolerant status, was greater in the REM group than DEX group at 15 min and 3 h (15 min: 83% vs. 61%, P=0.029; 3 h: 92% vs. 74%, P=0.016), although the mean mitigation rate (81% vs. 85%, P=0.800) was comparable between the two groups. NIV failure, defined as reintubation or death over the course of study, was comparable between the two groups (19.2% vs. 21.1%, respectively, P=0.831). There were no significant differences between the two groups in other clinical outcomes, including tracheostomy (15.4% vs. 15.8%, P=0.958), in-hospital mortality (11.5% vs. 10.5%, P=0.880), ICU length of stay (LOS) (7 vs. 7 days, P=0.802), and in-hospital LOS (17 vs. 19 days, P=0.589).

Conclusions: REM was as effective as DEX in CS patients with moderate to severe NIV intolerance. Although the effect of REM was better than that of DEX over the first 3 h, the cumulative effect was similar between the two treatments.

Keywords: Remifentanil; cardiac surgery; dexmedetomidine; non-invasive ventilation.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-20-1678). The authors have no conflicts of interest to declare.

2020 Journal of Thoracic Disease. All rights reserved.

Figures

Figure 1
Figure 1
A flow diagram of this study. NIS, noninvasive ventilation intolerance score.
Figure 2
Figure 2
PSA chart for clinical status of CS patients with NIV treated with DEX (A) and REM (B). PSA, percentage stacked area.
Figure 3
Figure 3
The time-dependent therapeutic effects of two sedative drugs.

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Source: PubMed

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