Clinical Studies (General)


Kliniska Studier Allmänna


Inhalation sedation with the ‘Anaesthetic Conserving Device’ for patients in intensive care units: A literature review.

Author
Karnjus et al
Signa Vitae 2016

Objective
The Anaesthetic Conserving Device is a modified heat and moisture exchanger that enables the application of inhalation sedation with existing ventilators in intensive care units. The following review describes the advantages of inhalation sedation using the Anaesthetic Conserving Device in comparison to standard intravenous sedation for patients in intensive care units and highlights the technical aspects of its functioning.

Findings
Use of inhalation sedation with the Anaesthetic Conserving Device enables faster transition to spontaneous breathing and a shorter awakening time than with intravenous sedation. Even short-term inhalation sedation of patients after open heart procedures has a cardioprotective effect and reduces troponin T values. Despite increased concentrations of inorganic fluoride in serum after sevoflurane exposure, no clinical studies to date have shown its nephrotoxic effect, even after long-term (48 h) sedation. The Anaesthetic Conserving Device is accurate in maintaining target values of volatile anaesthetics. However, increased dead space volume was found in several studies, exceeding the internal volume of the Anaesthetic Conserving Device.”

Objective
Results to date show that inhalation sedation with the Anaesthetic Conserving Device may be an effective and safe alternative to existing protocols of intravenous sedation for patients requiring intensive treatment.

Volatile Anesthetics Is a New Player Emerging in Critical Care Sedation

Author
Jerath et al
Critical Care Medicine 2016

Abstract
Volatiles have expanded beyond the operating room secondary to technological advances attracting the attention of clinicians and researchers trying to improve sedation therapy and outcomes. Their unique pharmacological properties may account for shorter patient awakening and extubation times in comparison to the current standard of care. However, like all sedatives, these agents can induce deep levels of sedation that have respiratory depressant effects and reduce patient mobility. At this time, it would be prudent to conduct further research to ensure patient safety with a focus on mortality, duration of mechanical ventilation, clinically relevant end-organ protection, and early and long-term cognitive dysfunction before widespread adoption of this exciting technique.

Conclusion
Volatile anesthetic agent use in the intensive care unit, aided by technological advances, has become more accessible to critical care physicians. With increasing concern over adverse patient consequences associated with our current sedation practice, there is growing interest to find non-benzodiazepine-based alternative sedatives. Research has demonstrated that volatile-based sedation may provide superior awakening and extubation times in comparison with current intravenous sedation agents (propofol and benzodiazepines). Volatile agents may possess important end-organ protective properties mediated via cytoprotective and anti-inflammatory mechanisms. However, like all sedatives, volatile agents are capable of deeply sedating patients, which can have respiratory depressant effects and reduce patient mobility. This review seeks to critically appraise current volatile use in critical care medicine including current research, technical consideration of their use, contraindications, areas of controversy, and proposed future research topics.

Sevoflorane as adjuvant for sedation during mechanical ventilation in intensive care unit medical patients: Preliminary results of a series of cases.

Author
Lopez-Ramos et al
Colombian Journal of Anesthesiology 2015

Objective
To disclose our preliminary experience in inhalation sedation with sevoflorane in a standardized manner using the Anesthetic Conserving Device in intubated, critically ill patients in our ICU.

Findings
A proper implementation of the protocol by physicians and the nursing staff has been achieved, meeting the goals established for sedation (RASS 0, −2) free of hepatic or renal adverse outcomes or side effects.

Conclusion
In our limited experience, adjuvant inhalation sedation with sevoflurane in the ICU is safe and complementary to the use of intravenous drugs such as propofol, remifentanil and midazolam, which are currently commonly used to achieve goal-directed sedation.

Survival after long-term isoflurane sedation as opposed to intravenous sedation in critically ill surgical patients.

Author
Bellgardt et al
Eur J Anaesthesiol March 2015

Objective
The objective of this study is to compare mortality after sedation with either isoflurane or propofol/midazolam.

Findings
Consecutive cohort of 369 critically ill surgical patients defined within the database of the hospital information system. All patients were continuously ventilated and sedated for more than 96h between 1 January 2005 and 31 December 2010. After excluding 169 patients (93>79years old, 10<40 years old, 46 mixed sedation, 20 lost to follow up), 200 patients were studied, 72 after isoflurane and 128 after propofol/ midazolam. After sedation with isoflurane, the in-hospital mortality and 365-day mortality were significantly lower than after propofol/midazolam sedation: 40 versus 63% (P¼0.005) and 50 versus 70% (P¼0.013), respectively. After adjustment for potential confounders (coronary heart disease, chronic obstructive pulmonary disease, acute renal failure, creatinine, age and Simplified Acute Physiology Score II), patients after isoflurane were at a lower risk of death during their hospital stay (OR 0.35; 95% CI 0.18 to 0.68, P¼0.002) and within the first 365 days (OR 0.41; 95% CI 0.21 to 0.81, P¼0.010).

Conclusion
Compared with propofol/midazolam sedation, long-term sedation with isoflurane seems to be well tolerated in this group of critically ill patients after surgery.