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Noninvasive positive-pressure ventilation (NIPPV) is used commonly for patients with acute respiratory distress due to congestive heart failure and reactive airways, but agitation limits some patients' ability to tolerate the mask. Dexmedetomidine is an alpha-2 agonist, like clonidine, and thus may decrease adrenergic drive and agitation without suppressing the respiratory drive. To evaluate dexmedetomidine for sedation during NIPPV, investigators at two U.S. centers randomized 33 patients with acute respiratory failure to receive intravenous dexmedetomidine or placebo according to a prespecified titration scheme (infusion without initial bolus at a rate of 0.2 µg/kg/h, titrated by 0.1 µg/kg/h every 30 minutes to a maximum of 0.7 µg/kg/h). …