In this episode, I’ll discuss inhaled sedation for ICU patients with acute respiratory distress syndrome.
Using inhaled sedatives such as sevoflurane in ICU patients who require mechanical ventilation has been explored more in research settings in the hopes that it will result in fewer episodes of ICU delirium. A group of authors have published in JAMA a randomized clinical trial to determine the efficacy and safety of inhaled sevoflurane compared with intravenous propofol for sedation in patients with acute respiratory distress syndrome (ARDS).
The trial included nearly 700 patients with early moderate to severe ARDS (defined by a ratio of PaO2 to the fraction of inspired oxygen of <150 mm Hg with a positive end-expiratory pressure of ≥8 cm H2O) in 37 French intensive care units. Patients were randomized to either inhaled sedation with sevoflurane (referred to as the intervention group) or IV sedation with propofol (referred to as the control group) for up to 7 days. The primary end point was the number of ventilator-free days by day 28, and a secondary end point was 90-day survival. The sevoflurane group had an average of 2 fewer ventilator-free days by day 28, a difference that was statistically significant. In addition, the 90-day survival rates were 47.1% and 55.7% in the sevoflurane and propofol groups, respectively for a hazard ratio of 1.31 that was statistically significant. Patients in the sevoflurane group were also more likely to die within 7 days and less likely to be transferred out of the ICU within 28 days. The authors concluded:
Among patients with moderate to severe ARDS, inhaled sedation with sevoflurane resulted in fewer ventilator-free days at day 28 and lower 90-day survival than sedation with propofol.
These results not only do not support using sevoflurane for sedation in the ICU for patients with ARDS, but they may also affect the likelihood that future studies with sevoflurane are conducted given the disturbing increase in patient mortality at both 7 and 90 days in this study.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
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