Grant: Operating Grant: Clinical Trials Projects

When patients have life-threatening breathing problems, they often require help from a breathing machine called non-invasive ventilation (NIV). NIV is similar to a continuous positive airway pressure (CPAP) machine that someone would use for sleep apnea, but more powerful. Unfortunately, patients can find it hard to tolerate as the mask is tight-fitting, the air pressure in the mask can make breathing uncomfortable, and patients can have nausea and vomiting as air gets pushed into the stomach. When NIV is not tolerated (or the breathing condition gets worse) doctors often have to put a breathing tube into the lungs and use a machine (mechanical ventilation) to do all the breathing until the lungs get better. Using the breathing tube and mechanical ventilation instead of NIV increases the chance of dying in the ICU, developing lung infections, worsens muscle weakness, and lengthens the hospital stay. Sedating patients with medication(s) may help their tolerance of NIV. However, the medications that are used most often typically slow down (or stop) breathing and therefore cannot be used in patients who do not have a breathing tube. However, a medication called dexmedetomidine does not have any effect on breathing, reduces 'stress', can treat pain, and makes patients relaxed and sleepy, but allows them to be woken up very easily. To date, 12 studies have shown dexmedetomidine improves the ability of patients to tolerate NIV. However, the studies were very small and doctors cannot actually tell if using dexmedetomidine reduces the need to switch to an invasive breathing tube and mechanical ventilation. Therefore, we are proposing a study to definitively determine if using dexmedetomidine will improve the ability of patients with life-threatening breathing problems to tolerate NIV and avoid having a breathing tube inserted and placed on mechanical ventilation.