Résumé
Le confort du patient sous ventilation non invasive (VNI) est une des clés majeures de la réussite de cette technique de support ventilatoire. Malgré l’optimisation des interfaces, des réglages et des paramètres ventilatoires, un certain nombre de patients doivent être intubés du fait de leur intolérance à la VNI. Même si l’usage d’agents sédatifs est fréquemment rapporté dans la littérature, seuls quelques travaux prospectifs proposent des protocoles de sédation adaptés à cette situation. Sous couvert de précautions strictes, avec des produits d’action courte et idéalement administrés en « objectif de concentration », la sédation semble pouvoir être envisagée afin de permettre la poursuite de la VNI en cas d’intolérance, permettant ainsi de diminuer l’incidence du recours à l’intubation. L’objectif de la sédation n’est pas de retarder une intubation rendue nécessaire du fait de l’état du patient, mais bien de permettre la poursuite de la VNI en cas d’intolérance ou d’inconfort majeur du patient.
Abstract
One major key of success of non-invasive ventilation (NIV) is the patient’s comfort. Despite the optimization of interfaces, settings, and ventilatory parameters, some patients have to be intubated because of low NIV tolerance. Adapted sedation can overcome this difficulty, aiming to reduce intubation incidence. Even if the use of sedative agents is frequently reported in the literature, only a few prospective studies have tested sedation protocols adapted to this situation. Administration of drugs with rapid onset and short duration of action, using target-controlled infusion should avoid NIV failure due to patient’s intolerance. Sedation objective is not to delay intubation but rather to allow NIV continuation in case of intolerance or major discomfort.
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Clouzeau, B., Vargas, F., Boyer, A. et al. Place et modalités de la sédation au cours de la ventilation non invasive. Réanimation 20, 389–396 (2011). https://doi.org/10.1007/s13546-011-0283-6
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DOI: https://doi.org/10.1007/s13546-011-0283-6