Table 1 Items and statements

What is the rationale for analgosedation during NRS (NPPV, CPAP, and HFT) treatment and which patients could benefit from it?

Statement 1.1

During noninvasive respiratory support (NPPV, CPAP, and HFNT), the use of an analgosedation strategy should be considered in adult patients with hypoxemic or hypercapnic ARF of various etiologies who need to be managed for anxiety, agitation, delirium, dyspnea, and intolerance or pain

Regardless of the type of NRS used, close clinical monitoring proportional to the type of support used is mandatory

Statement 1.2

Before the implementation of analgosedation during NRS treatment, the absence of factors specifically related to the condition of respiratory failure (severity or evolution) or inappropriate settings should be carefully assessed to minimize the risk of NRS failure

What available pharmacological strategies could be implemented for analgosedation during noninvasive respiratory support?

Statement 2.1

According to the latest scientific evidence, analgosedation during NRS might be considered to improve adherence to treatments and clinical outcomes. These strategies can be implemented when there are no signs of deterioration, lack of response to NRS, and contraindications to the used pharmacological agents. Although there is no ideal medication and/or protocol for analgosedation during NRS, dexmedetomidine could be considered the drug of choice in patients with closely monitored vital signs (such as blood pressure, heart rate, saturation, and observational sedation scales)

In the case of analgosedation during noninvasive respiratory support use, how should patients be monitored and what parameters should be considered?

Statement 3.1

For analgosedation during NRS, cardiorespiratory monitoring and assessment of consciousness using observational scales should be performed to achieve an appropriate sedation plan and to avoid oversedation. For analgosedation during NRS, cardiorespiratory monitoring and assessment of consciousness using observational scales should be performed to achieve an appropriate sedation plan and to avoid oversedation, monitoring the patients with predefined observational sedation scales and predefined parameters

What analgosedation targets should be reached according to the reason for NRS use (full treatment or palliative treatment)?

Statement 4.1

For analgosedation during NRS, the use of close cardiorespiratory monitoring and assessment of consciousness through observational scales should be performed to achieve an adequate sedation plan and avoid oversedation

What is the most appropriate timing to start or end analgosedation during NRS?

Statement 5.1

The administration of analgesic and/or sedative drugs in patients undergoing NRS can be initiated at two different times: at the start of treatment to improve patient comfort and prevent the onset of patient intolerance or during the NRS as “rescue treatment” at the onset of intolerance and refusal of NRS. However, there are no data in the literature to establish the best time to initiate analgesia e/o sedation during the NRS

Statement 5.2

In the case of NRS intolerance, analgosedation may reduce the incidence of tracheal intubation. However, it should only be used as a last resort after having excluded all the other causes of discomfort and after attempting non-pharmacological measures (such as interface replacement, improving ventilator synchrony, noise reduction, and humidification). Nevertheless, analgosedation should never delay tracheal intubation, potentially masking patient discomfort due to NRS ineffectiveness

Is the choice of the analgosedative influenced by the type of respiratory failure (acute de novo, chronic exacerbated, postoperative) that led to NRS use?

Statement 6.1

The type of respiratory failure and the reasons for prescribing a given drug are among the factors to be considered when choosing analgosedation. In the case of hypercapnic respiratory failure, drugs depressing respiratory activity should be avoided. If intolerance is mainly related to pain, drugs with a predominant analgesic effect should be preferred. In cases of discomfort primarily due to anxiety, drugs capable of producing light sedation or anxiolysis may be more appropriate

Should analgosedative strategies during NRS be adapted in the case of immunocompromised patients, and are there any specific issues related to this particular population?

Statement 7.1

No available data indicates the existence of specificities in analgosedation, in terms of indications, pharmacological techniques, targets, and monitoring needs, for immunocompromised patients. In the absence of specific evidence, the use of analgosedation during NRS should follow strategies used in immunocompetent patients

Statement 7.2

As in immunocompetent patients, it is also crucial for immunocompromised patients to avoid delaying tracheal intubation which remains an urgent and nondeferrable intervention in patients failing NRS

What are the most appropriate settings to conduct analgosedation during NRS treatment?

Statement 8.1

When applying an analgosedation strategy during NRS treatment, it is of pivotal importance to consider the most appropriate monitoring and the clinical setting. For this purpose, the level of intensity of care, the health professional team experience, and the individual patient’s clinical characteristics should be carefully assessed