Dexmedetomidine versus midazolam versus propofol infusion for sedation of patients with non invasive ventilation in acute respiratory failure

Background: Non-invasive ventilation (NIV) is widely utilized in ICUs for acute respiratory failure (ARF), but 40% of cases fail due to patient intolerance, limiting its effectiveness. Aim: To compare the sedative effect of dexmedetomidine, midazolam, and propofol and their effect on hemodynamics and respiration in critically ill patients with NIV intolerance in acute respiratory failure. Patients and methods: This prospective randomized research (2022–2025) compared dexmedetomidine, midazolam, and propofol for sedation in 105 ICU patients with acute respiratory failure during NIV. Patients were divided into three equal groups (n=35 each) receiving dexmedetomidine (0.2–0.7 μg/kg/h), midazolam (0.02–0.1 mg/kg/h), or propofol (0.6–4 mg/kg/h) for up to 48h, assessing sedative and hemodynamic effects. Results: The study compared dexmedetomidine, midazolam, and propofol groups, finding comparable baseline Bispectral Index (BIS), Richmond Agitation-Sedation Scale (RASS), Ramsay Sedation Scale (RSS), heart rate (HR), and oxygen saturation (SpO2). Post-sedation, all groups showed significant decreases in BIS, RASS, and HR, and increases in RSS and SpO2 (P<0.001). Dexmedetomidine exhibited significantly higher BIS and RASS scores, lower RSS scores, and lower HR compared to midazolam and propofol (P1, P2<0.05 to <0.001 at various time points), with no significant differences between midazolam and propofol (P3>0.05). SpO2 showed no inter-group differences (P>0.05). Incidents of bradycardia, hypotension, and delirium were also comparable across groups (P>0.05). Conclusion: Dexmedetomidine, midazolam, and propofol improved NIV success in ARF patients, enhancing oxygenation. Dexmedetomidine is preferred for calmer, more alert sedation compared to midazolam and propofol.