Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review

PURPOSE: In this retrospective study, we compared inhaled sedation with isoflurane to intravenous propofol in invasively ventilated COVID-19 patients with ARDS (Acute Respiratory Distress Syndrome). METHODS: Charts of all 20 patients with COVID-19 ARDS admitted to the ICU of a German University Hosp...

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Autores principales: Kermad, Azzeddine, Speltz, Jacques, Danziger, Guy, Mertke, Thilo, Bals, Robert, Volk, Thomas, Lepper, Philipp M., Meiser, Andreas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Singapore 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225486/
https://www.ncbi.nlm.nih.gov/pubmed/34169362
http://dx.doi.org/10.1007/s00540-021-02960-6
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author Kermad, Azzeddine
Speltz, Jacques
Danziger, Guy
Mertke, Thilo
Bals, Robert
Volk, Thomas
Lepper, Philipp M.
Meiser, Andreas
author_facet Kermad, Azzeddine
Speltz, Jacques
Danziger, Guy
Mertke, Thilo
Bals, Robert
Volk, Thomas
Lepper, Philipp M.
Meiser, Andreas
author_sort Kermad, Azzeddine
collection PubMed
description PURPOSE: In this retrospective study, we compared inhaled sedation with isoflurane to intravenous propofol in invasively ventilated COVID-19 patients with ARDS (Acute Respiratory Distress Syndrome). METHODS: Charts of all 20 patients with COVID-19 ARDS admitted to the ICU of a German University Hospital during the first wave of the pandemic between 22/03/2020 and 21/04/2020 were reviewed. Among screened 333 days, isoflurane was used in 97 days, while in 187 days, propofol was used for 12 h or more. The effect and dose of these two sedatives were compared. Mixed sedation days were excluded. RESULTS: Patients’ age (median [interquartile range]) was 64 (60–68) years. They were invasively ventilated for 36 [21–50] days. End-tidal isoflurane concentrations were high (0.96 ± 0.41 Vol %); multiple linear regression yielded the ratio (isoflurane infusion rate)/(minute ventilation) as the single best predictor. Infusion rates were decreased under ECMO (3.5 ± 1.4 versus 7.1 ± 3.2 ml∙h(−1); p < 0.001). In five patients, the maximum recommended dose of propofol of 4 mg∙hour(−1)∙kg(−1)ABW was exceeded on several days. On isoflurane compared to propofol days, neuro-muscular blocking agents (NMBAs) were used less frequently (11% versus 21%; p < 0.05), as were co-sedatives (7% versus 31%, p < 0.001); daily opioid doses were lower (720 [720–960] versus 1080 [720–1620] mg morphine equivalents, p < 0.001); and RASS scores indicated deeper levels of sedation (− 4.0 [− 4.0 to − 3.0] versus − 3.0 [− 3.6 to − 2.5]; p < 0.01). CONCLUSION: Isoflurane provided sufficient sedation with less NMBAs, less polypharmacy and lower opioid doses compared to propofol. High doses of both drugs were needed in severely ill COVID-19 patients.
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spelling pubmed-82254862021-06-25 Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review Kermad, Azzeddine Speltz, Jacques Danziger, Guy Mertke, Thilo Bals, Robert Volk, Thomas Lepper, Philipp M. Meiser, Andreas J Anesth Original Article PURPOSE: In this retrospective study, we compared inhaled sedation with isoflurane to intravenous propofol in invasively ventilated COVID-19 patients with ARDS (Acute Respiratory Distress Syndrome). METHODS: Charts of all 20 patients with COVID-19 ARDS admitted to the ICU of a German University Hospital during the first wave of the pandemic between 22/03/2020 and 21/04/2020 were reviewed. Among screened 333 days, isoflurane was used in 97 days, while in 187 days, propofol was used for 12 h or more. The effect and dose of these two sedatives were compared. Mixed sedation days were excluded. RESULTS: Patients’ age (median [interquartile range]) was 64 (60–68) years. They were invasively ventilated for 36 [21–50] days. End-tidal isoflurane concentrations were high (0.96 ± 0.41 Vol %); multiple linear regression yielded the ratio (isoflurane infusion rate)/(minute ventilation) as the single best predictor. Infusion rates were decreased under ECMO (3.5 ± 1.4 versus 7.1 ± 3.2 ml∙h(−1); p < 0.001). In five patients, the maximum recommended dose of propofol of 4 mg∙hour(−1)∙kg(−1)ABW was exceeded on several days. On isoflurane compared to propofol days, neuro-muscular blocking agents (NMBAs) were used less frequently (11% versus 21%; p < 0.05), as were co-sedatives (7% versus 31%, p < 0.001); daily opioid doses were lower (720 [720–960] versus 1080 [720–1620] mg morphine equivalents, p < 0.001); and RASS scores indicated deeper levels of sedation (− 4.0 [− 4.0 to − 3.0] versus − 3.0 [− 3.6 to − 2.5]; p < 0.01). CONCLUSION: Isoflurane provided sufficient sedation with less NMBAs, less polypharmacy and lower opioid doses compared to propofol. High doses of both drugs were needed in severely ill COVID-19 patients. Springer Singapore 2021-06-25 2021 /pmc/articles/PMC8225486/ /pubmed/34169362 http://dx.doi.org/10.1007/s00540-021-02960-6 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Kermad, Azzeddine
Speltz, Jacques
Danziger, Guy
Mertke, Thilo
Bals, Robert
Volk, Thomas
Lepper, Philipp M.
Meiser, Andreas
Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review
title Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review
title_full Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review
title_fullStr Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review
title_full_unstemmed Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review
title_short Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review
title_sort comparison of isoflurane and propofol sedation in critically ill covid-19 patients—a retrospective chart review
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225486/
https://www.ncbi.nlm.nih.gov/pubmed/34169362
http://dx.doi.org/10.1007/s00540-021-02960-6
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