Sedation in non-invasive ventilation: do we know what to do (and why)?

Table 1 Summary of studies making any report of sedation use in the context of NIV in adults with critical illness (compiled from Burns et al.[2])

Study	No. of patients	Patient characteristics	Experimental NIV strategy	Sedation status
Hill et al. 2000 [4]	21	ARF	VPAP in ST-A mode	Sedation protocol reportedly used. Study published as abstract only
Nava et al. 1998 [5]	50	Exacerbation of COPD; mechanical ventilation for at least 36–48 h	Non-invasive pressure support on conventional ventilator delivered with face mask	Sedation reportedly used during NIV but apparently not protocolized or defined
Prasad et al. 2009 [6]	30	COPD; AHRF	Bilevel NIV (pressure mode) delivered by full face mask	Patients received neuromuscular blocking drugs and sedatives in immediately preceding phase of invasive ventilation. Use of sedation during NIV not clear
Rabie Agmy et al. 2004 [7]	37	Exacerbation of COPD	Proportional-assist NIV in timed mode, delivered by face or nasal mask	Patients received neuromuscular blocking drugs and sedatives in immediately preceding phase of invasive ventilation. Use of sedation during NIV not clear
Vaschetto et al. 2012 [8]	20	Hypoxaemic respiratory failure; invasive mechanical ventilation for at least 48 h	Helmet NIV	Sedation reportedly used during NIV but apparently not protocolized or defined. Rates of continuous sedation during NIV reported to be similar in both groups (a priori study outcome)

In all the studies, the control strategy used was invasive pressure support.
ARF, acute respiratory failure; AHRF, acute hypercapnic respiratory failure; ST, spontaneous/timed; VPAP, variable positive airway pressure.

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