Volatile Sedation Research Articles

Isoflurane Sedation on the ICU in Cardiac Arrest Patients Treated With Targeted Temperature Management: An Observational Propensity-Matched Study.

Targeted temperature management after cardiac arrest requires deep sedation to prevent shivering and discomfort. Compared to IV sedation, volatile sedation has a shorter half-life and thus may allow more rapid extubation and neurologic assessment. Observational analysis of clinical data. University hospital, medical ICU. Four hundred thirty-two cardiac arrest survivors underwent targeted temperature management; of those, 110 were treated with volatile sedation using an anesthetic conserving device and isoflurane, and 322 received standard IV sedation. No intervention. A matched pairs analysis revealed that time on ventilator (difference of median, 98.5 hr; p = 0.003) and length of ICU stay (difference of median, 4.5 d; p = 0.006) were significantly shorter in patients sedated with isoflurane when compared with IV sedation although no differences in neurologic outcome (45% of patients with cerebral performance category 1-2 in both groups) were observed. Significant hypercapnia occurred more frequently during anesthetic conserving device use (6.4% vs 0%; p = 0.021). Volatile sedation is feasible in cardiac arrest survivors. Prospective controlled studies are necessary to confirm the beneficial effects on duration of ventilation and length of ICU stay observed in our study. Our data argue against a major effect on neurologic outcome. Close monitoring of PaCO2 is necessary during sedation via anesthetic conserving device.

Fluoride levels with long-term volatile sedation within the intensive care unit

The prognosis of the patients who treated with high-flow nasal cannulae compared to continuous positive airway pressure therapy in severe acute exacerbation of chronic obstructive pulmonary disease Myoung kyu Lee, Sang-ha Kim, Suk joong Yong, Kye chul Shin, Jiwon Choi, Yeun seoung Choi, Ye-ryung Jung, Seok jeong Lee, Won-yeon Lee Yonsei University Wonju College of Medicine, Republic of Korea Background/Purpose: Although high-flow nasal cannula (HFNC) oxygen therapy has been used gradually as a method of respiratory support, its evidence is still lacking. Noninvasive positive pressure ventilation (NIPPV) has been used in chronic obstructive pulmonary disease (COPD) patients, especially with severe acute exacerbation of COPD (AECOPD). The purpose of this study is to investigate and compare the prognosis of severe AECOPD patients who were treated with HFNC therapy and NIPPV. Methods: We conducted a prospective randomized controlled trial to compare HFNC therapy with NIPPV for patients (≥40 years old) with severe AECOPD in a tertiary referral hospital. Seventy-two patients with severe AECOPD having mild to moderate respiratory failure were enrolled in this prospective study. We evaluated 30-day mortality and the duration switching from 2 devices to conventional oxygen therapy. Results: The mean age was 72.2 ± 9.4 years (76.4% of male), and mortality rate was 16.6%. Forty-two patients (72.0 ± 9.1) were managed with HFNC oxygen therapy, and 30 patients (73.1 ± 10.4), with NIPPV. Thirty-day mortality was 14.0% and 19.0% (P = .313) in each treatment group, and the duration switching from 2 devices to conventional oxygen therapy was 7.1 ± 6.6 and 6.4 ± 7.8 days (P= .105), respectively. Conclusions: In severe AECOPD patients with mild to moderate respiratory failure, HFNC oxygen therapy compared to NIPPV did not show a statistical difference in 30-day mortality and the duration until the AECOPD gets improved. We expect that HFNC can be used as substitute in severe AECOPD patient requiring NIPPV; however, more prospective and multicenter studies should be required.

Volatile isoflurane sedation in cerebrovascular intensive care patients using AnaConDa®: effects on cerebral oxygenation, circulation, and pressure

The anesthetic-conserving device AnaConDa(®), a miniature vaporizer, allows volatile sedation in the intensive care unit (ICU). We investigated the effects of isoflurane sedation on cerebral and systemic physiology parameters in neuromonitored ICU stroke patients. Included in the study were 19 consecutive ventilated patients with intracerebral hemorrhage (12), subarachnoid hemorrhage (4), and ischemic stroke (3) who were switched from intravenous propofol or midazolam to inhalative isoflurane sedation for an average of 3.5 days. During the sedation transition, the following parameters were assessed: mean arterial pressure (MAP), intracranial pressure (ICP), cerebral perfusion pressure (CPP), middle cerebral artery mean flow velocity (MFV) and cerebral fractional tissue oxygen extraction (FTOE), as well as systemic cardiopulmonary parameters and administered drugs. After the first hour, mean ICP showed an increase of 2.1 mmHg that was not clinically relevant. Likewise, MFV did not change. MAP and CPP, however, decreased by 6.5 and 6.3 mmHg, respectively. FTOE was reduced slightly from 0.24 to 0.21 (p = 0.03). Over an observation period of 12 h, ICP remained stable, while MAP and thus CPP showed distinct decreases (CPP: -10 mmHg at 6 h, p < 0.001; -7.5 mmHg at 12 h, p = 0.005, when compared to preswitch levels) despite a 1.5-fold increase in vasopressor administration. We suggest that that it is possible to reach sufficient sedation levels in cerebrovascular ICU patients by applying volatile isoflurane long-term without a relevant increase in ICP, if baseline ICP values are low or only moderately elevated. However, caution should be exercised in view of isoflurane's decreasing effect on MAP and CPP. Multimodal neuromonitoring is strongly recommended when applying this off-label sedation method.