Inhaled Sedation in Patients with COVID-19-Related Acute Respiratory Distress Syndrome: An International Retrospective Study

Abstract

Background and objectives: The coronavirus disease 2019 (COVID-19) pandemic and the shortage of intravenous sedatives has led to renewed interest in inhaled sedation for patients with acute respiratory distress syndrome (ARDS). We hypothesized that inhaled sedation would be associated with improved clinical outcomes in COVID-19 ARDS patients. Methods: Retrospective international study including mechanically ventilated patients with COVID-19 ARDS who required sedation and were admitted to 10 European and US intensive care units. The primary endpoint of ventilator-free days through day 28 was analyzed using zero-inflated negative binomial regression, before and after adjustment for site, clinically relevant covariates determined according to the univariate results, and propensity score matching. Results: A total of 196 patients were enrolled, 78 of whom died within 28 days. The number of ventilator-free days through day 28 did not differ significantly between the patients who received inhaled sedation for at least 24 h (n = 111) and those who received intravenous sedation only (n = 85), with medians of 0 (interquartile range [IQR] 0–8) and 0 (IQR 0–17), respectively (odds ratio for having zero ventilator-free days through day 28, 1.63, 95% confidence interval [CI], 0.91–2.92, p = 0.10). The incidence rate ratio for the number of ventilator-free days through day 28 if not 0 was 1.13 (95% CI, 0.84–1.52, p = 0.40). Similar results were found after multivariable adjustment and propensity matching. Conclusion: The use of inhaled sedation in COVID-19 ARDS was not associated with the number of ventilator-free days through day 28.

Sevoflurane sedation in COVID-19 acute respiratory distress syndrome: an observational study with a propensity score matching model

“…Despite this limitation, our study found a positive association between treatment with sevoflurane and a reduction in overall mortality in treated patients, suggesting a potential protective factor. However, further analysis is needed to identify possible confounding factors and to strengthen these outcome data ( 33 ). Increasing the sample size could provide further strength to these outcome data.…”

Sedation with Sevoflurane versus Propofol in COVID-19 Patients with Acute Respiratory Distress Syndrome: Results from a Randomized Clinical Trial

“…Our results are consistent with previous analysis [ 30 , 42 , 43 , 44 , 45 ], which found no differences between inhaled and intravenous sedation in deaths or length of ICU stay. An international retrospective study including 10 ICUs published in 2022 [ 46 ] found no association between inhaled sedation in COVID-19 patients and the number of ventilator-free days through to day 28; this suggests that the effect of treatment on mortality probably does not depend on the resulting changes in the PaO 2 /FiO 2 ratio.…”

Sevoflurane sedation in COVID-19 acute respiratory distress syndrome: an observational study with a propensity score matching model

“…Despite this limitation, our study found a positive association between treatment with sevoflurane and a reduction in overall mortality in treated patients, suggesting a potential protective factor. However, further analysis is needed to identify possible confounding factors and to strengthen these outcome data (34). Increasing the sample size could provide further strength to these outcome data.…”