Inhalation Sedation in Subjects With ARDS Undergoing Continuous Lateral Rotational Therapy

Meiser, Andreas; Groesdonk, Heinrich V.; Bonnekessel, Sarah; Volk, Thomas; Bomberg, Hagen

doi:10.4187/respcare.05751

Cited by 26 publications

(14 citation statements)

References 30 publications

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“…Also, the opioid dose was significantly lower on isoflurane compared to propofol days. A reduced opioid dose may facilitate spontaneous breathing [37,38] and promote intestinal motility.…”

Section: Discussionmentioning

confidence: 99%

Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review

et al. 2021

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Purpose In this retrospective study, we compared inhaled sedation with isoflurane to intravenous propofol in invasively ventilated COVID-19 patients with ARDS (Acute Respiratory Distress Syndrome). Methods Charts of all 20 patients with COVID-19 ARDS admitted to the ICU of a German University Hospital during the first wave of the pandemic between 22/03/2020 and 21/04/2020 were reviewed. Among screened 333 days, isoflurane was used in 97 days, while in 187 days, propofol was used for 12 h or more. The effect and dose of these two sedatives were compared. Mixed sedation days were excluded. Results Patients’ age (median [interquartile range]) was 64 (60–68) years. They were invasively ventilated for 36 [21–50] days. End-tidal isoflurane concentrations were high (0.96 ± 0.41 Vol %); multiple linear regression yielded the ratio (isoflurane infusion rate)/(minute ventilation) as the single best predictor. Infusion rates were decreased under ECMO (3.5 ± 1.4 versus 7.1 ± 3.2 ml∙h−1; p < 0.001). In five patients, the maximum recommended dose of propofol of 4 mg∙hour−1∙kg−1ABW was exceeded on several days. On isoflurane compared to propofol days, neuro-muscular blocking agents (NMBAs) were used less frequently (11% versus 21%; p < 0.05), as were co-sedatives (7% versus 31%, p < 0.001); daily opioid doses were lower (720 [720–960] versus 1080 [720–1620] mg morphine equivalents, p < 0.001); and RASS scores indicated deeper levels of sedation (− 4.0 [− 4.0 to − 3.0] versus − 3.0 [− 3.6 to − 2.5]; p < 0.01). Conclusion Isoflurane provided sufficient sedation with less NMBAs, less polypharmacy and lower opioid doses compared to propofol. High doses of both drugs were needed in severely ill COVID-19 patients.

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“…Also, the opioid dose was significantly lower on isoflurane compared to propofol days. A reduced opioid dose may facilitate spontaneous breathing [37,38] and promote intestinal motility.…”

Section: Discussionmentioning

confidence: 99%

Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review

et al. 2021

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“…Whether spontaneous respiration in ARDS is helpful or harmful remains an area of debate [8]. Clinical studies confirmed that sedation inhibits the driving of the respiratory center and reduces the amplitude of spontaneous respiration, especially for early moderate to severe ARDS, deep sedation and even muscle relaxation can greatly improve the prognosis of patients and reduce the incidence of VILI [9,10]. However, for mild ARDS or convalescent ARDS, it is recommended to keep spontaneous respiration, which may be more conducive to the recovery of the disease.…”

Section: Introductionmentioning

confidence: 99%

Effect of Deep Sedation on Mechanical Power in Moderate to Severe Acute Respiratory Distress Syndrome: A Prospective Self-Control Study

Xie

Cao

Qian

et al. 2020

BioMed Research International

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Mechanical power (MP) is a parameter for assessing ventilator-induced lung injury (VILI) in patients with acute respiratory distress syndrome (ARDS). Deep sedation inhibits the respiratory center and reduces the excessive spontaneous breathing in ARDS patients, thereby reducing transpulmonary pressure (Ptp) and lung injury. However, the effect of sedation on MP in ARDS patients is not yet clear. Therefore, the purpose of this study was to investigate the effect of deep sedation on MP in ARDS patients. Patients with moderate to severe ARDS who required mechanical ventilation were considered. Different degrees of sedation were performed on patients in three stages after 24 hours of mechanical ventilation. The three stages are as follows: stage 1 (H+3): 0 to 3 hours of sedation; patients’ Ramsay score was 2-3 to obtain mild sedation; stage 2 (H+6): 4 to 6 hours of sedation; the sedation depth was adjusted to 5-6 points; and stage 3 (H+9): 7 to 9 hours of sedation; the sedation depth was adjusted to 2-3 points. Under deep sedation (H+6), MP, respiratory rate (RR), and Ptp were significantly lower than the ones in the patients under mild sedation (H+3) (all P<0.01) although PaO2/FiO2 (P/F) and static lung compliance (Cst) were significantly higher (both P<0.01). However, no significant difference in the above parameters was observed between H+3 and H+9. Correlation analysis showed that ΔMP was significantly and positively correlated with ΔRR and ΔPtp (both P<0.001), while no correlation was observed neither between ΔMP and ΔCst nor between ΔMP and ΔP/F. The 28-day Kaplan-Meier survival curve showed the occurrence of 19 deaths, and the overall survival rate was 63.46%. The survival rate was 53.12% in the high-MP (HMP) group and 80.95 in the low-MP (LMP) group (P<0.05). In conclusion, deep sedation significantly reduced MP in patients with moderate to severe ARDS, thereby reducing the occurrence of VILI. In addition, MP monitoring in deep sedation predicted the 28-day survival of patients with moderate to severe ARDS.

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“…The prerequisite for using the Anaesthetic Conserving Device (ACD) AnaConDa ® (Sedana Medical AB, Danderyd, Sweden) or the MIRUS TM system (TIM, Koblenz, Germany) depends on several clinical parameters (see Figure 1 ). If lung compliance is acceptable, and CO 2 can be reduced sufficiently, both types of systems are able to maintain spontaneous breathing[ 19 - 21 ]. However, if lung compliance is poor, reduction of dead space and active humidification is necessary, which can be facilitated by inhaled sedation via a circle breathing system[ 22 , 23 ].…”

Section: Administration Of Volatile Anesthetics During Ards Therapymentioning

confidence: 99%

Extracorporeal membrane oxygenation and inhaled sedation in coronavirus disease 2019-related acute respiratory distress syndrome

Bellgardt¹,

Özcelik²,

Breuer-Kaiser³

et al. 2021

WJCCM

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Coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome (ARDS) is a severe complication of infection with severe acute respiratory syndrome coronavirus 2, and the primary cause of death in the current pandemic. Critically ill patients often undergo extracorporeal membrane oxygenation (ECMO) therapy as the last resort over an extended period. ECMO therapy requires sedation of the patient, which is usually achieved by intravenous administration of sedatives. The shortage of intravenous sedative drugs due to the ongoing pandemic, and attempts to improve treatment outcome for COVID-19 patients, drove the application of inhaled sedation as a promising alternative for sedation during ECMO therapy. Administration of volatile anesthetics requires an appropriate delivery. Commercially available ones are the anesthetic gas reflection systems AnaConDa ® and MIRUS TM , and each should be combined with a gas scavenging system. In this review, we describe respiratory management in COVID-19 patients and the procedures for inhaled sedation during ECMO therapy of COVID-19 related ARDS. We focus particularly on the technical details of administration of volatile anesthetics. Furthermore, we describe the advantages of inhaled sedation and volatile anesthetics, and we discuss the limitations as well as the requirements for safe application in the clinical setting.

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Inhalation Sedation in Subjects With ARDS Undergoing Continuous Lateral Rotational Therapy

Abstract: This study supports the feasibility of isoflurane sedation using continuous lateral rotational therapy.

Cited by 26 publications

References 30 publications

Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review

Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review

Effect of Deep Sedation on Mechanical Power in Moderate to Severe Acute Respiratory Distress Syndrome: A Prospective Self-Control Study

Extracorporeal membrane oxygenation and inhaled sedation in coronavirus disease 2019-related acute respiratory distress syndrome

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