RT Journal Article SR Electronic T1 The role of sedation in NIV JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP PA2153 DO 10.1183/13993003.congress-2016.PA2153 VO 48 IS suppl 60 A1 Rachel Jones A1 Ari Manuel A1 Steve Twigg YR 2016 UL http://erj.ersjournals.com/content/48/suppl_60/PA2153.abstract AB Introduction: Ventilation strategies can be limited by agitation including NIV[1]. Remifentanil is a rapidly metabolised opiate that offers sedative properties with reported success in the ICU with intubated patients[2].Aims: To assess whether it is appropriate to use remifentanil with NIV to improve compliance in patients with COPD related ventilatory failure.Methods: A retrospective, five year, observational study at a UK ICU investigating remifentanil prescriptions via the controlled drug record. Patients that had received NIV and had COPD were identified and collated.Results: 13% (30/225) NIV admissions managed with remifentanil sedation had COPD related ventilatory failure. Those with COPD and those with Non-COPD admissions were similar in age (65y (SD 7.7) vs 63y (SD 16.5)), time on NIV (2 days (SD 1.25) vs 3 days (SD 1.92)) and length of stay (2 days (SD 1.4) vs 3 days (SD 2.7)).The COPD NIV group required on average 40% less sedation than those without COPD. NIV with remifentanil sedation was 26% more successful (e.g. no progression to intubation) in patients with COPD compared to those without (p=0.02).NIV-success (No ETT)NIV-failure (ETT)COPD77% (23/30)23% (7/30)Non- COPD51% (99/195)49% (96/195)Remifentanil in COPD vs Non COPD PatientsConclusion: NIV and remifentanil sedation is significantly better in patients with COPD although there may be confounding factors. While ICU bed provision is extremely limited it is possible that NIV and remifentanil could be trialled in respiratory High Dependency Units as a comparison to NIV alone.[1] Davies BTS NIV Audit 2013[2] Rozendaal et al. Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay. Intensive Care Med 2009;35:291-98.