Abstract
Noninvasive positive pressure ventilation (NPPV) has been reported to be effective for acute respiratory failure in patients with severe asthma. Although NPPV requires less sedative than invasive mechanical ventilation, agitated patients with severe asthma should be given the minimum sedation necessary to facilitate the induction of NPPV. Two asthmatic patients (a 65-year-old man and a 32-year-old woman) separately presented to the intensive care unit with exacerbating respiratory failure. We initiated NPPV using bilevel positive airway pressure (PAP) ventilation. The ventilation was initially set as an inspiratory PAP of 15 cmH2O and an expiratory PAP of 4 cmH2O. Because they seemed too agitated to tolerate the mask ventilation, dexmedetomidine was administered intravenously, at 3 μg·kg−1·min−1 for 10 min, followed by a continuous infusion at 0.2–0.6 μg·kg−1·min−1. One hour after the institution of NPPV, the patients were well cooperative with the mask ventilation and the respiratory symptoms had markedly improved. While the Ramsay sedation scale was maintained at 2 or 3 during the continuous dexmedetomidine infusion, we successfully weaned the patients from NPPV by reducing the inspiratory PAP. Dexmedetomidine helped the agitated patients cooperate with mask ventilation without inducing respiratory depression. We conclude that dexmedetomidine may be a valuable sedative to facilitate the induction of NPPV.
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Meduri GU, Cook TR, Turner RE, Cohen M, Leeper KV. Noninvasive positive pressure ventilation in status asthmaticus. Chest. 1996;110:767–774.
Fernandez MM, Villagra A, Blanch L, Fernandez R. Noninvasive mechanical ventilation in status asthmaticus. Intensive Care Med. 2001;27:486–492.
Soroksky A, Stav D, Shpirer I. A pilot prospective, randomized, placebo-controlled trial of bilevel positive airway pressure in acute asthmatic attack. Chest. 2003;123:1018–1025.
Soma T, Hino M, Kida K, Kudoh S. A prospective and randomized study for improvement of acute asthma by non-invasive positive pressure ventilation (NPPV). Intern Med. 2008;47:493–501.
Mehta S, Hill NS. Noninvasive ventilation. Am J Respir Crit Care Med. 2001;163:540–577.
Venn RM, Hell J, Grounds RM. Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care. Crit Care. 2000;4:302–308.
Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000;90:699–705.
Martin E, Ramsay G, Mantz J, Sum-Ping ST. The role of the α2-adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit. J Intensive Care Med. 2003;18:29–41.
Talke P, Li J, Jain U, Leung J, Drasner K, Hollenberg M, Mangano DT, The Study of Perioperative Ischemia Research Group. Effects of perioperative dexmedetomidine infusion in patients undergoing vascular surgery. Anesthesiology. 1995;82:620–633.
Talke P, Chen R, Thomas B, Aggarwall A, Gottlieb A, Thorborg P, Heard S, Cheung A, Son SL, Kallio A. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg. 2000;90:834–839.
Pandharipande PP, Pun BT, Herr DL, Maze M, Girard TD, Miller RR, Shintani AK, Thompson JL, Jackson JC, Deppen SA, Stiles RA, Dittus RS, Bernard GR, Wesley Ely E. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007;298:2644–2653.
Groeben H, Mitzner W, Brown RH. Effects of the α2-adrenoceptor agonist dexmedetomidine on bronchoconstriction in dogs. Anesthesiology. 2004;100:399–363.
Ram FS, Wellington S, Rowe BH, Wedzicha JA. Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma. Cochrane Database Syst Rev. 2005;1:CD004360.
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This case report was presented in part at the 81st clinical and scientific congress of the International Anesthesia Research Society, Orlando, Florida, March 23–27, 2007.
An erratum to this article is available at http://dx.doi.org/10.1007/s00540-009-0762-3.
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Takasaki, Y., Kido, T. & Semba, K. Dexmedetomidine facilitates induction of noninvasive positive pressure ventilation for acute respiratory failure in patients with severe asthma. J Anesth 23, 147–150 (2009). https://doi.org/10.1007/s00540-008-0712-5
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DOI: https://doi.org/10.1007/s00540-008-0712-5