Effect of sedation with inhaled anaesthetics on cognitive and psychiatric outcomes in critically ill adults: a systematic review protocol

Cuninghame, Sean; Gorsky, Kevin; Francoeur, Conall; Withington, Davinia E.; Burry, Lisa; Jerath, Angela; Slessarev, Marat

doi:10.1136/bmjopen-2021-052893

Cited by 3 publications

(2 citation statements)

References 31 publications

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“…This is a rare complication, particularly of sevoflurane use through the potential lowering of renal aquaporin-2 receptors that help to concentrate urine (24, 25). Evidence examining the neurocognitive and long-term effects of ICU volatile use is limited, but current data show equivalent effects on ICU delirium (22, 26).…”

Section: Discussionmentioning

confidence: 97%

Inhaled Volatiles for Status Asthmaticus, Epilepsy, and Difficult Sedation in Adult ICU and PICU: A Systematic Review

Gorsky,

Cuninghame,

Jayaraj

et al. 2024

Critical Care Explorations

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OBJECTIVES: Inhaled volatile anesthetics support management of status asthmaticus (SA), status epilepticus (SE), and difficult sedation (DS). This study aimed to evaluate the effectiveness, safety, and feasibility of using inhaled anesthetics for SA, SE, and DS in adult ICU and PICU patients. DATA SOURCES: MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. STUDY SELECTION: Primary literature search that reported the use of inhaled anesthetics in ventilated patients with SA, SE, and DS from 1970 to 2021. DATA EXTRACTION: Study data points were extracted by two authors independently. Quality assessment was performed using the Joanna Briggs Institute appraisal tool for case studies/series, Newcastle criteria for cohort/case–control studies, and risk-of-bias framework for clinical trials. DATA SYNTHESIS: Primary outcome was volatile efficacy in improving predefined clinical or physiologic endpoints. Secondary outcomes were adverse events and delivery logistics. From 4281 screened studies, the number of included studies/patients across diagnoses and patient groups were: SA (adult: 38/121, pediatric: 28/142), SE (adult: 18/37, pediatric: 5/10), and DS (adult: 21/355, pediatric: 10/90). Quality of evidence was low, consisting mainly of case reports and series. Clinical and physiologic improvement was seen within 1–2 hours of initiating volatiles, with variable efficacy across diagnoses and patient groups: SA (adult: 89–95%, pediatric: 80–97%), SE (adults: 54–100%, pediatric: 60–100%), and DS (adults: 60–90%, pediatric: 62–90%). Most common adverse events were cardiovascular, that is, hypotension and arrhythmias. Inhaled sedatives were commonly delivered using anesthesia machines for SA/SE and miniature vaporizers for DS. Few (10%) of studies reported required non-ICU personnel, and only 16% had ICU volatile delivery protocol. CONCLUSIONS: Volatile anesthetics may provide effective treatment in patients with SA, SE, and DS scenarios but the quality of evidence is low. Higher-quality powered prospective studies of the efficacy and safety of using volatile anesthetics to manage SA, SE, and DS patients are required. Education regarding inhaled anesthetics and the protocolization of their use is needed.

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Section: Discussionmentioning

confidence: 97%

Inhaled Volatiles for Status Asthmaticus, Epilepsy, and Difficult Sedation in Adult ICU and PICU: A Systematic Review

Gorsky,

Cuninghame,

Jayaraj

et al. 2024

Critical Care Explorations

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View full text Add to dashboard Cite

show abstract

“…36 Although the data Volatile Anesthetic Intensive Care Unit Sedation are limited, a recent meta-analysis of 13 studies did not demonstrate any significant differences between volatile and intravenous ICU sedation in the incidence of delirium or long-term cognitive dysfunction. 37 Currently, there are multiple multicenter randomized trials underway seeking to provide further clarity on these important outcomes (NCT04341350, NCT05327296, NCT05312385).…”

Section: Neurologic and Cognitive Effectsmentioning

confidence: 99%