PurposeNoninvasive positive pressure ventilation (NIV) is a common intervention used to treat acute respiratory failure. Unfortunately, many patients find NIV intolerable, ultimately leading to NIV failure, and the need for escalation to intubation and invasive mechanical ventilation (IMV). Hypothetically, sedation may treat NIV intolerance, thereby preventing the need for IMV. We hypothesized that there may be variability in practice regarding the use of sedation to treat NIV intolerance. Our primary aim was to assess if sedatives are used during NIV, and if so, which agents.MethodsWe created an 18-question survey that addressed demographics, the use of sedatives during NIV, the use of dexmedetomidine specifically, and attitudes and beliefs towards sedative use during NIV. The Hamilton Integrated Research Ethics Board (Hamilton, ON, Canada) approved the survey for global distribution. We used REDCap™ to electronically disseminate the survey in four countries (Australia, Canada, New Zealand, and Saudi Arabia).ResultsWe received 140 responses from active practicing adult intensivists for an approximate response rate of 8%. Most intensivists (88%) reported that they would not administer a sedative to prevent NIV intolerance when a patient is not agitated. Overall, 44% of intensivists rarely or never give a sedative to treat NIV intolerance, 18% prescribe a sedative half the time, and 38% usually or always prescribe a sedative to improve NIV intolerance.ConclusionsThis international survey showed variability and equipoise on beliefs and attitudes regarding the use of sedatives to treat NIV intolerance. This must be considered in the context of a low response rate and may not represent the whole spectrum of opinions. Nevertheless, our findings likely justify the need for comprehensive research to outline the potential benefit and harm of using sedation in critically ill patients receiving NIV who are intolerant.