Remifentanil Sedation: A Five Year Retrospective Case Series Focusing on its Role in Non-Invasive Ventilation

Abstract

This is a retrospective observational study of practice in the intensive care unit (ICU) of a 700-bed district general hospital in the UK, which aims to describe the indications for remifentanil sedation in current critical care practice, with particular reference to its use in patients who are unable to tolerate non-invasive ventilation (NIV). Controlled drug records were analysed over a five year period and each prescription of remifentanil matched against patient records to determine the indication, dose and duration of use, alongside significant clinical events. Where patients received NIV, the duration of use and days of remifentanil sedation (if appropriate) were recorded. During the study period, a total of 3,259 patients were admitted to the ICU, of whom 469 (14.4%) received remifentanil. The majority of patients, n=286 (61.0%) received remifentanil while not intubated; for 232 (81.1%) it was prescribed to enable them to tolerate NIV. In this group, the mean duration of remifentanil infusion was 2.55 days, with the mean dose 4.55 mg/day, equivalent to approximately 0.04 μg/kg/min. Of the patients who were intubated, the most common indication was as part of a weaning strategy, the patients having previously been given longer acting agents. Due to its unique pharmacokinetic profile, remifentanil is used in a variety of specific clinical situations in our practice, in both intubated and non-intubated patients. In particular, we provide data to confirm its role as a safe and effective sedative in patients who are unable to tolerate NIV.