The impact of the coronavirus pandemic on sedation in critical care: volatile anesthetics in the ICU

Abstract

Purpose of review To reflect on the impact of the coronavirus pandemic on sedation for mechanically ventilated patients. Recent findings Shortages of intravenous sedatives during coronavirus pandemic renewed interest in using widely available inhaled anaesthetics for sedation of critically ill patients. Universally used for surgical anaesthesia, inhaled anaesthetics may offer therapeutic advantages in patients with acute lung injury with good sedation profiles, rapid clearance and lower lung inflammation in pilot trials. However, enabling ICU sedation with inhaled anaesthetics required technological and human resource innovation during the chaos of the global pandemic. The disruption of standard sedation practices is challenging during normal operations, yet pandemic facilitated innovation in this field by fostering cross-discipline collaboration supported by healthcare professionals, hospitals, research institutes and regulators. Summary Although further research is needed to establish the role of inhaled anaesthetics in critical care sedation toolkit, maintaining the spirit of innovation ignited during the recent coronavirus pandemic would require ongoing collaboration and streamlining of processes among healthcare, research and regulatory institutions.

Patient Self-Inflicted Lung Injury—A Narrative Review of Pathophysiology, Early Recognition, and Management Options

“…Landoni et al's meta-analysis found a reduced need for intravenous sedatives and opioids when using inhalation sedation [58]. Alongside sedation, inhaled anesthetics may provide other clinical benefits-bronchodilatation, reduced inflammation, improved gas exchange, and facilitated awakening [63,64].…”