Dexmedetomidine Versus Standard Clinical Practice During Non Invasive Mechanical Ventilation

Exclusion Criteria

• •Respiratory arrest, direct indication of OTI and IMV.
• •Severe unstable comorbidity (myocardial ischemia with ejection fraction \<30%, arrythmia, uncontrolled hypotension defined as systolic blood pressure less than 90 mmHg with doses of norepinephrine\>0.5 mcg/kg/min and/or dobutamine\>10 mcg/kg/min).
• •Inability to protect the airway: bronchial aspiration.
• •Fixed upper airway obstruction.
• •Tracheostomy.
• •Undrained pneumothorax.
• •Severe agitation or lack of collaboration of the patient despite medication administered.
• •Facial burns or trauma.
• •Facial surgery or anatomical changes which prevent mask fitting.
• •Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
• •Allergy to eggs, soya, or peanuts.
• •HR\< 50 bpm not induced by beta- blockers.
• •Advanced heart block (grade 2 or 3) unless paced.
• •Acute cerebrovascular conditions.
• •Increased intracranial pressure.
• •Closed angle glaucoma.
• •Myasthenia gravis.
• •Concurrent use of CYP3A4 inhibitors (amprenavir, atazanavir, or ritonavir).
• •Refuse to participate in the trial.
• •Pregnant or nursing patients.