Remifentanil-based sedation to treat noninvasive ventilation failure: a preliminary study

Intensive Care Med. 2007 Jan;33(1):82-7. doi: 10.1007/s00134-006-0447-4. Epub 2006 Nov 14.


Objective: To assess the feasibility and safety of remifentanil-based sedation during noninvasive ventilation (NIV) in patients with NIV failure.

Design and setting: Prospective clinical investigation in a 16-bed intensive care unit of a university hospital in France.

Patients: Thirteen patients in NIV failure due to discomfort and/or refusal to continue this ventilatory support: 10 with acute respiratory failure and 3 with acute hypercapnic respiratory failure.

Intervention: Patients were administered methylene blue and were sedated (Ramsay scale 2-3) by a continuous perfusion of remifentanil during NIV. Cardiorespiratory and ventilatory parameters, blood gas analysis, and adverse events were prospectively recorded.

Measurements and results: The 13 patients received a total of 125 NIV sessions, totaling 1200 h, of NIV under remifentanil-based sedation (mean remifentanil dose 0.1+/-0.03 microg/kg per minute). Three patients also required propofol. PaO2/FIO2 ratio increased from 134+/-69 to 187+/-43 mmHg after 1 h. In patients with acute respiratory failure respiratory rate decreased from 34+/-12 per minute before remifentanil to 25+/-4 per minute after 1h. In the three patients with acute hypercapnic respiratory failure PaCO2 decreased from 69+/-7 to 42+/-5 mmHg. Four patients required endotracheal intubation without aspiration pneumonia. Twelve of the 13 patients left the ICU.

Conclusion: This pilot study shows that remifentanil-based sedation is safe and effective in the treatment of NIV failure due to low tolerance.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Conscious Sedation*
  • Female
  • Humans
  • Hypnotics and Sedatives / therapeutic use*
  • Male
  • Middle Aged
  • Piperidines / therapeutic use*
  • Prospective Studies
  • Remifentanil
  • Respiration, Artificial*
  • Respiratory Insufficiency / therapy*
  • Treatment Failure


  • Hypnotics and Sedatives
  • Piperidines
  • Remifentanil