Abstract
In recent years, inhaled sedation has been increasingly used in the intensive care unit (ICU). The aim of this prospective, controlled trial was to compare washout and awakening times after long term sedation with desflurane and isoflurane both administered with the Mirus™ system (TIM GmbH, Koblenz, Germany). Twenty-one consecutive critically ill patients were alternately allocated to the two study groups, obtaining inhaled sedation with either desflurane or isoflurane. After 24 h study sedation, anesthetic washout curves were recorded, and a standardized wake-up test was performed. The primary outcome measure was the time required to decrease the endtidal concentration to 50% (T50%). Secondary outcome measures were T80% and awakening times (all extremities moved, RASS −2). Decrement times (min) (desflurane versus isoflurane, median (1st quartile—3rd quartile)) (T50%: 0.3 (0.3–0.4) vs. 1.3 (0.4–2.3), log-rank test P = 0.002; P80%: 2.5 (2–5.9) vs. 12.1 (5.1–20.2), P = 0.022) and awakening times (to RASS −2: 7.5 (5.5–8.8) vs. 41.0 (24.5–43.0), P = 0.007; all extremities moved: 5.0 (4.0–8.5) vs. 13.0 (8.0–41.25), P = 0.037) were significantly shorter after desflurane compared to isoflurane. The use of desflurane with the Mirus™ system significantly shortens the washout times and leads to faster awakening after sedation of critically ill patients.
Highlights
The principle of anesthetic reflection permits efficient use of volatile anesthetics with common intensive care unit (ICU) ventilators [1]
One patient allocated to the isoflurane group dropped out after developing acute coronary syndrome and being taken for coronary catheterization
One desflurane patient with severe sepsis and septic encephalopathy did not show any signs of awakening during 60 min
Summary
The principle of anesthetic reflection permits efficient use of volatile anesthetics with common intensive care unit (ICU) ventilators [1]. Volatile anesthetics have been increasingly used for inhaled sedation of invasively ventilated critically ill patients [2]. They are referred to in National guidelines as alternative drugs for sedation, especially when deep sedation and rapid awakening are required [3,4,5]. The M IRUSTM system (TIM GmbH, Koblenz, Germany) (Figure 1) was introduced in 2013 and comprises a gas and a ventilation monitor, along with an administration unit for isoflurane, sevoflurane, or desflurane [6]. A control unit is connected via a multi-lumen cable with the M IRUSTM Exchanger which comprises a total internal volume of 100 mL interposed between ventilator hoses and the endotracheal tube.
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