The New MIRUS System for Short-Term Sedation in Postsurgical ICU Patients*

Romagnoli, Stefano; Chelazzi, Cosimo; Villa, Gianluca; Zagli, Giovanni; Benvenuti, Francesco; Mancinelli, Paola; Arcangeli, Giulio; Dugheri, Stefano; Bonari, Alessandro; Tofani, Lorenzo; Belardinelli, A.; Gaudio, Angelo Raffaele De

doi:10.1097/ccm.0000000000002465

Cited by 20 publications

(11 citation statements)

References 21 publications

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“…Measurements were taken 15 cm up from the MIRUS™ system and 15 cm from the reflector. These authors found that the mean SEVO concentrations were 0.15‐0.17 ppm, which were very similar to our results during baseline measurements and similar to pollution values using ISO and DES …”

Section: Discussionsupporting

confidence: 91%

Environmental safety: Air pollution while using MIRUS™ for short‐term sedation in the ICU

Herzog-Niescery

Vogelsang

Gude

et al. 2018

Acta Anaesthesiol Scand

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Section: Discussionsupporting

confidence: 91%

Environmental safety: Air pollution while using MIRUS™ for short‐term sedation in the ICU

Herzog-Niescery

Vogelsang

Gude

et al. 2018

Acta Anaesthesiol Scand

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“…ISO, the cheapest VA, costs 0.39 € h −1 ; propofol, in comparison, about 0.41 € h −1 for an infusion rate of 3 mg kg −1 h −1 . Although comparable studies are rare, Romagnoli and colleagues reported nearly identical results for SEVO of approximately 8 ml for a slightly lower MAC of 0.45 [17]. Another observation, a case report of an obese woman suffering from acute respiratory distress syndrome after aspiration of gastric contents, demonstrated a twofold higher VA consumption of 53 ml h −1 DES to reach a fraction of 3.3–3.8% (3.21% in this study) [18].…”

Section: Discussionmentioning

confidence: 98%

“…Furthermore, devices to reduce atmospheric VA pollution must be considered. Studies have shown that an air-conditioning with at least six air changes per hour and a scavenging system should be used to reach mean VA concentrations below 1 ppm in the patient room (the National Institute of Occupational Safety and Health has defined an exposure limit of 2 ppm for ISO, SEVO, and DES in the air) [16, 17].…”

Section: Discussionmentioning

confidence: 99%

Use of MIRUS™ for MAC-driven application of isoflurane, sevoflurane, and desflurane in postoperative ICU patients: a randomized controlled trial

Bellgardt

Georgevici

Klutzny

et al. 2019

Ann. Intensive Care

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BackgroundThe MIRUS™ (TIM, Koblenz, Germany) is an electronical gas delivery system, which offers an automated MAC (minimal alveolar concentration)-driven application of isoflurane, sevoflurane, or desflurane, and can be used for sedation in the intensive care unit. We investigated its consumption of volatile anesthetics at 0.5 MAC (primary endpoint) and the corresponding costs. Secondary endpoints were the technical feasibility to reach and control the MAC automatically, the depth of sedation at 0.5 MAC, and awakening times. Mechanically ventilated and sedated patients after major surgery were enrolled. Upon arrival in the intensive care unit, patients obtained intravenous propofol sedation for at least 1 h to collect ventilation and blood gas parameters, before they were switched to inhalational sedation using MIRUS™ with isoflurane, sevoflurane, or desflurane. After a minimum of 2 h, inhalational sedation was stopped, and awakening times were recorded. A multivariate electroencephalogram and the Richmond Agitation Sedation Scale (RASS) were used to assess the depth of sedation. Vital signs, ventilation parameters, gas consumption, MAC, and expiratory gas concentrations were continuously recorded.ResultsThirty patients obtained inhalational sedation for 18:08 [14:46–21:34] [median 1st–3rd quartiles] hours. The MAC was 0.58 [0.50–0.64], resulting in a Narcotrend Index of 37.1 [30.9–42.4] and a RASS of − 3.0 [− 4.0 to (− 3.0)]. The median gas consumption was significantly lowest for isoflurane ([ml h−1]: isoflurane: 3.97 [3.61–5.70]; sevoflurane: 8.91 [6.32–13.76]; and desflurane: 25.88 [20.38–30.82]; p < 0.001). This corresponds to average costs of 0.39 € h−1 for isoflurane, 2.14 € h−1 for sevoflurane, and 7.54 € h−1 for desflurane. Awakening times (eye opening [min]: isoflurane: 9:48 [4:15–20:18]; sevoflurane: 3:45 [0:30–6:30]; desflurane: 2:00 [1:00–6:30]; p = 0.043) and time to extubation ([min]: isoflurane: 10:10 [8:00–20:30]; sevoflurane: 7:30 [4:37–14:22]; desflurane: 3:00 [3:00–6:00]; p = 0.007) were significantly shortest for desflurane.ConclusionsA target-controlled, MAC-driven automated application of volatile anesthetics is technically feasible and enables an adequate depth of sedation. Gas consumption was highest for desflurane, which is also the most expensive volatile anesthetic. Although awakening times were shortest, the actual time saving of a few minutes might be negligible for most patients in the intensive care unit. Thus, using desflurane seems not rational from an economic perspective.Trial registration Clinical Trials Registry (ref.: NCT03860129). Registered 24 September 2018—Retrospectively registered.

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“…Sedation delivery, clinical and EEG-based depth assessment MIRUS™ (TIM, Koblenz, Germany) delivered inhalational sedation by employing an inhalational anaesthetic re ector, which features a controller to maintain the age-adjusted MAC pre-set target, regardless of changes in ow and minute-ventilation (9,10). The device continuously recorded the concentration of iso urane, sevo urane, or des urane.…”

Section: Randomizationmentioning

confidence: 99%

Negative Drift of Sedation Depth In Critically Ill Patients Receiving Constant Minimum Alveolar Concentration of Isoflurane, Sevoflurane, or Desflurane: A Randomized Controlled Trial

Georgevici

Kyprianou

Herzog-Niescery

et al. 2021

Preprint

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Background: Intensive care unit (ICU) physicians have extended the minimum alveolar concentration (MAC) to deliver and monitor long-term volatile sedation in critically ill patients. There is limited evidence of MAC’s reliability in controlling sedation depth in this setting. We hypothesized that sedation depth, measured by the electroencephalography (EEG)-derived Narcotrend-Index (burst-suppression N_Index 0 – awake N_Index 100), might drift downward over time despite constant MAC values.Methods: This prospective single-centre randomized clinical study was conducted at a University Hospital Surgical Intensive Care Unit and included consecutive, postoperative ICU patients fulfilling the inclusion criteria. Patients were randomly assigned to receive uninterrupted inhalational sedation with isoflurane, sevoflurane, or desflurane. The end-expiratory concentration of the anaesthetics and the EEG-derived index were measured continuously in time-stamped pairs. Sedation depth was also monitored using Richmond-Agitation-Sedation-Scale (RASS). The paired t-test and linear models (bootstrapped or multilevel) have been employed to analyze MAC, N_Index and RASS across the three groups. Results: Thirty patients were recruited (female/male: 10/20, age 64±11, Simplified Acute Physiology Score II 30±10). In the first 24 hours, 21.208 pairs of data points (N_Index and MAC) were recorded. The median MAC of 0.58±0.06 remained stable over the sedation time in all three groups. The t-test indicated in the isoflurane and sevoflurane groups a significant drop in RASS and EEG-derived N_Index in the first versus last two sedation hours. We applied a multilevel linear model on the entire longitudinal data, nested per patient, which produced the formula N_Index=43−0.7·hours (R2=0.76), showing a strong negative correlation between sedation’s duration and the N_Index. Bootstrapped linear models applied for each sedation group produced: N_Index of 43–0.9, 45–0.8, and 43–0.4·hours for isoflurane, sevoflurane, and desflurane, respectively. The regression coefficient for desflurane was almost half of those for isoflurane and sevoflurane, indicating a less pronounced time-effect in this group.Conclusions: Maintaining constant MAC does not guarantee stable sedation depth. Thus, the patients necessitate frequent clinical assessments or, when unfeasible, continuous EEG monitoring. The differences across different volatile anaesthetics regarding their time-dependent negative drift requires further exploration.Trial registration: NCT03860129.

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The New MIRUS System for Short-Term Sedation in Postsurgical ICU Patients*

Cited by 20 publications

References 21 publications

Environmental safety: Air pollution while using MIRUS™ for short‐term sedation in the ICU

Environmental safety: Air pollution while using MIRUS™ for short‐term sedation in the ICU

Use of MIRUS™ for MAC-driven application of isoflurane, sevoflurane, and desflurane in postoperative ICU patients: a randomized controlled trial

Negative Drift of Sedation Depth In Critically Ill Patients Receiving Constant Minimum Alveolar Concentration of Isoflurane, Sevoflurane, or Desflurane: A Randomized Controlled Trial

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