REM vs. DEX for NIV Intolerance
Trial question
What is the role of remifentanil in cardiac surgery patients with moderate-to-severe intolerance to noninvasive ventilation?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
31.0% female
69.0% male
N = 179
179 patients (56 female, 123 male).
Inclusion criteria: adult cardiac surgery patients with moderate-to-severe intolerance to noninvasive ventilation.
Key exclusion criteria: VAS score ≥ 4; history of allergy to any study drug constituents; expectoration difficulty; severe liver dysfunction; renal failure.
Interventions
N=89 remifentanil (initial dosage of 0.05 mcg/kg/min with infusion rate adjusted at increments of 0.01 mcg/kg/min; target noninvasive ventilation intolerance score ≤ 2).
N=90 dexmedetomidine (initial dosage of 0.5 mcg/kg/h with infusion rate adjusted at increments of 0.01 mcg/kg/h; target noninvasive ventilation intolerance score ≤ 2).
Primary outcome
Successfull mitigation of noninvasive ventilation intolerance at 15-minute timepoint
42%
20%
42.0 %
31.5 %
21.0 %
10.5 %
0.0 %
Remifentanil
Dexmedetomidine
Significant
increase ▲
NNT = 4
Significant increase in successfull mitigation of noninvasive ventilation intolerance at 15-minute timepoint (42% vs. 20%; RR 2.1, 95% CI 0.77 to 3.43).
Secondary outcomes
No significant difference in noninvasive ventilation failure (5.6% vs. 7.8%; RR 0.72, 95% CI -1.66 to 3.1).
No significant difference in death in the hospital (1.12% vs. 2.22%; RR 0.5, 95% CI -1.16 to 2.16).
No significant difference in in-hospital reintubation (7.87% vs. 10%; RR 0.79, 95% CI -2.2 to 3.78).
Safety outcomes
Significant difference in adverse events (0% vs. 10%).
Conclusion
In adult cardiac surgery patients with moderate-to-severe intolerance to noninvasive ventilation, remifentanil was superior to dexmedetomidine with respect to successfull mitigation of noninvasive ventilation intolerance at 15-minute timepoint.
Reference
Guang-Wei Hao, Jia-Qing Wu, Shen-Ji Yu et al. Remifentanil vs. dexmedetomidine for cardiac surgery patients with noninvasive ventilation intolerance: a multicenter randomized controlled trial. J Intensive Care. 2024 Sep 18;12(1):35.
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