Analgosedation practice during noninvasive respiratory supports: Results from an Italian survey

Purpose: There are currently no established guidelines pertaining the application of analgosedation strategies for patients undergoing Noninvasive Respiratory Supports (NRSs) for acute respiratory failure treatment. The Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) conducted a nation-wide survey to describe the current clinical practice in the management of analgosedation during NRSs. Methods: This is a nationwide online survey, involving Italian anesthesiologist-intensivists, developed by experts affiliated with SIAARTI. Invitations to participate were distributed via emails and social networks. Data were collected over a period of three months (March 16 to May 10, 2024). Results: Two hundred and seventy-seven full responses were collected. Most respondents were attending physician (83 %), with <10 years of ICU experience (56 %) and work in ICU medical department (75 %). In terms of optimizing the NRS success, 80 % of respondents used a pharmacological strategy and 50 % of respondents did not use a non-pharmacological strategy. Dexmedetomidine was the most commonly administered drug (82 %), followed by morphine and remifentanil. Additionally, 33 % of respondents reported using a combination of dexmedetomidine and remifentanil as part of their pharmacological strategy during NRSs. Concerning the motivations for analgosedation use during NRSs, over 80 % of respondents aimed to improve patient-ventilator interaction, more than 60 % focused on reducing patient anxiety and dyspnea, 59 % sought for having a lower respiratory rate, and only 40 % prioritized pain reduction. Conclusion: Sedation is frequently used in patients with acute respiratory failure undergoing NRSs. Current analgesic practices are becoming more standardized, with analgosedation strategies increasingly tailored to individual patient characteristics.