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Use of Sedation During Non-Invasive Ventilation in Intensive Care Unit: A Systematic Review and Meta-Analysis
Carmine Iacovazzo1, Andrea Uriel de Siena1, Katarzyna Kotfis2,3,4
1Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples, Federico II, 80131 Naples, Italy.
Journal of Personalized Medicine
|July 27, 2026
Summary
Sedation during non-invasive ventilation (NIV) may improve success rates and reduce endotracheal intubation (ETI) in critically ill patients. Dexmedetomidine showed promise but increased risks of bradycardia and hypotension, requiring tailored patient strategies.
Area of Science:
- Critical Care Medicine
- Respiratory Medicine
- Pharmacology
Background:
- Non-invasive ventilation (NIV) is a standard treatment for acute respiratory failure (ARF) to prevent endotracheal intubation (ETI).
- Sedation is commonly employed during NIV to enhance patient comfort and tolerance.
- The impact of different sedation strategies on NIV outcomes, including ETI rates and success, requires thorough investigation.
Purpose of the Study:
- To systematically analyze the effect of sedation on endotracheal intubation (ETI) rates and NIV success in critically ill patients.
- To compare the efficacy and safety of various sedative agents used during non-invasive ventilation.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, EMBASE, MEDLINE, Web of Science, CENTRAL) up to September 2023.
- Included studies comprised prospective observational studies, retrospective cohort studies (nRCTs), and randomized controlled trials (RCTs).
- Primary outcomes were NIV success and ETI rates; secondary outcomes included hypotension, bradycardia, 28-day mortality, delirium, and oversedation.
Main Results:
- Analysis of 7 RCTs (738 patients) indicated dexmedetomidine increased NIV success (RR=1.167) and reduced ETI rates (RR=0.553) but raised bradycardia (RR=2.172) and hypotension (RR=2.441) risks.
- Retrospective studies (nRCTs) showed higher NIV success (Proportion=0.694) and moderate ETI rates (Proportion=0.379) with low rates of bradycardia and hypotension.
- Dexmedetomidine was associated with increased bradycardia and hypotension, particularly when compared to midazolam.
Conclusions:
- Sedation strategies, especially those utilizing dexmedetomidine, may improve NIV success and decrease ETI rates in critically ill patients.
- Dexmedetomidine use is linked to a higher incidence of bradycardia and hypotension, necessitating careful patient selection and monitoring.
- Optimal sedation requires individualized patient assessment, considering hemodynamic stability, delirium risk, and overall mortality risk.
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