Sedation Therapy In Patients With ICU And Respiratory Failure Noninvasive Ventilation (NPPV) Applications

Purpose:In order to clear whether sedation therapy can improve the therapeutic effect of noninvasive ventilation in ICU, The patients with respiratory failure treating by noninvasive ventilation were selected, then used dexmedetomidine and midazolam respectively, and observed the change of circulation, respiration, mental state, and adverse reaction before and after the treatment. At the same time, we compared the treatment effects of the patients with noninvasive ventilation treated by dexmedetomidine and midazolam respectively, then to clear the efficacy and safety of the two drugs,Methods:In this search, 98 patients with respiratory failure were selected in ICU from March 2014 to December 2015, and all patients were treated by noninvasive ventilation(NPPV). Among the patients, 39 cases of the patients were type I respiratory failure and 59 cases were type II respiratory failure. In the group of type I respiratory failure,we randomly divided into two groups, as the observation group(Group IA), 20 cases of patients treated by dexmedetomidine, and 19 cases of patient as the control group(Group IC) with no sedation. In the group of type II respiratory failure, we randomly divided into two groups similar, as the observation group, 20 cases of patients treated by dexmedetomidine(Group IIA), 19 cases of patients treated by midazolam(Group IIB), and 20 cases of patient as the control group(Group IIC) with no sedation. Record the change of the blood gas, hemodynamics, ventilator pressure parameters indicators and sedation agitation score in each group before and after treatments. Record the adverse reactions of the group IIA and IIB. The performing statistical analysis of the data, to clear the change of circulation and respiration by sedation therapy in the respiratory failure patients with noninvasive ventilation, and to clear the adverse reactions of the two drugs.Result:1. The patients of IA, IC two groups before and after treatment with respiratory and hemodynamic indexes: The patients of IA group after treatment with Pa O2 / Fi O2 index increased significantly, RR, HR, MAP index decreased significantly, significant differences, with statistical significance(P<0.05). There was no significant difference in Pa CO2 index before and after treatment, which was not statistically significant(P>0.05). The RR, HR index of patients in IC group noninvasive ventilation for 4h lower than 2h, the difference is statistically significant(P < 0.05); the Pa O2 / Fi O2, Pa O2, MAP index of noninvasive ventilation for 2h and 4h was no significant difference, and there was no statistical significance(P > 0.05).2. The patients of IA, IC two groups before and after treatment with breathing machine pressure parameter index: The PSV and PEEP indexes of patients in IA group were significantly lower than that before treatment, the difference was significant(P<0.05). The PSV and PEEP index of patients in IC group were no significant difference for 2h and 4h of noninvasive ventilation, which was not statistically significant(P > 0.05).3. The patients of IA, IC two groups before and after treatment with the sedation agitation score: The patients in IA group after treatment with Riker score significantly lower than before treatment, the difference was significant, with statistical significance(P<0.05). There was no significant difference in Riker score for 2h and 4h of noninvasive ventilation in patients of IC group, and the difference was not significant(P>0.05).4. The patients of IIA, IIB, IIC three groups before and after treatment with respiratory and hemodynamic index: The patients of IIA, IIB groups after treatment with Pa O2 / Fi O2 index increased significantly, RR, HR, MAP index was significantly lower than that before treatment, significant differences, with statistical significance(P < 0.05). The Pa O2 / Fi O2 index of patients in IIC group noninvasive ventilation for 4h was higher than 2h, HR index decreased, which was statistically significant(P < 0.05); the RR, MAP, Pa CO2 index of noninvasive ventilation for 2h and 4h had no significant difference, does not have statistical significance(P > 0.05). After administration the HR, MAP, Pa CO2 index of patients in IIA group were lower than that of IIB group, RR index higher than in IIB group, the difference between groups was significantly, with statistical significance(P < 0.05); but after treatment the Pa O2 / Fi O2 index of patients in IIA, IIB groups had no significant difference, does not have statistical significance(P > 0.05). The RR, HR, MAP indexes of patients in IIA, IIB groups were lower than those of IIC group, the Pa O2/Fi O2 index was higher than those of IIC group, the difference was significant, with statistical significance(P<0.05).5. The patients of IIA, IIB, IIC three groups before and after treatment with breathing machine pressure parameter index: The PSV and PEEP indexes of patients in IIA group were significantly lower than that before treatment, the difference was significant, with statistical significance(P<0.05). The PSV and PEEP indexes of patients in IIB, IIC groups after treatment were no significantly lower than before, the difference was not significant, and there was no statistical significance(P>0.05).6. The patients of IIA, IIB, IIC three groups before and after treatment with the sedation agitation score: the Riker score of patients in IIA, IIB two groups after treatment was significantly lower than before treatment, the difference was statistically significant(P<0.05). The Riker score of patients in IIC group with noninvasive ventilation 2h and 4h was similar, no significant difference, and there was no statistically significant(P>0.05).7. The patients of IIA, IIB two groups with sedative effect: The sedation onset time of patients in IIA group longer than patients in IIB group and had significant differences compared with statistical significance(P < 0.05). The patients of IIA group after stopping the drug, the wake-up time was shorter than that of IIB group, the difference was significant, with statistical significance(P<0.05). The patients of IIA, IIB two groups after treatment, the success rate was 90%, 94.7%, the difference was not significant, not statistically significant(P>0.05). The sedation satisfaction of patients in IIA group was 70%, higher than 36.8% in IIB group, and the difference was statistically significant(P<0.05).8. The occurrence of adverse reactions of patients in IIA and IIB groups after treatment: The patients in IIA group with the total incidence of adverse reactions was 30%, 57.9% in IIB group, the difference was statistically significant(p<0.05).Conclusion:1. The patients of respiratory failure with noninvasive ventilation treatments in ICU, the patients of type I and type II respiratory failure, sedation therapy can achieve higher sedation success rate, then improve the treatment compliance of noninvasive ventilation, and reduce oxygen consumption of the organism. At the same tine, it can improve the blood gas, respiratory and hemodynamic parameters and improve the treatment effect of noninvasive ventilation.2. In the patients of type II respiratory failure with noninvasive ventilation in ICU, the effect of the sedation therapy used by dexmedetomidine was better than the group of midazolam, and has less respiratory depression, higher compatibility in noninvasive ventilation in the group of dexmedetomidine. In the group of dexmedetomidine, the wake-up time is shorter than the group of midazolam after stopping the drug, in this group, the incidence rate of the delirium was decreased obviously, and the occur rate of the total adverse reactions was low.