Continuous positive airway pressure (CPAP) is a type of positive airway pressure, where the air flow is introduced into the airways to maintain a continuous pressure to constantly stent the airways open, in people who are breathing spontaneously.
The application of CPAP maintains positive end expiratory pressure (PEEP), can decrease atelectasis, increases the surface area of the alveolus, improves V/Q matching, and hence, improves oxygenation.
Analgesia and sedation are essential components of care for critically ill patients, helping to relieve pain and anxiety, facilitate invasive procedures, reduce physiological stress and oxygen demand, and improve patient-ventilator synchrony. However, sedation practices vary considerably due to differences in institutional protocols, clinician preferences, and patient characteristics. Both inadequate and excessive sedation can adversely affect outcomes: untreated pain and agitation increase the sympathetic stress response, while oversedation is associated with prolonged mechanical ventilation, longer intensive care unit (ICU) stays, and a higher incidence of delirium and coma.
Combinations of propofol, benzodiazepines and opioids are frequently used for sedation. Opioids are usually added in painful procedures because benzodiazepines and propofol do not have any analgesic effect. However, opioid administration can lead to excessive sedation and some side effects.
Propofol (non-opioid, non-barbiturate, short-acting anesthetic agent) is popular in sedation because of its rapid induction and recovery times. However, its side effects, particularly cardiopulmonary depression, apnea and hypoventilation, have attracted attention to the search for alternatives.
Ketamine can be an alternative to opioids because it provides good analgesia even at low doses, sparing the respiratory and cardiovascular adverse effects of opioids. Unfortunately, its side effects (increased salivation, nausea, nightmares, delirium, and excitation) do not make it favorable as a single agent.
The past few years have carried increased interest in dexmedetomidine (a selective alpha-2 receptor agonist) in both anesthesia and intensive care. This alpha-2 receptor agonist has been used as the drug of choice for sedation in pediatric patients because of its lack of respiratory depressive effects, adequate sedative and analgesic action, and favorable antiarrhythmic effects.
Furthermore, minimizing benzodiazepine use and preferentially using propofol or dexmedetomidine to achieve appropriate sedation levels are associated with improved clinical outcomes.