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Increased Respiratory Drive after Prolonged Isoflurane Sedation: A Retrospective Cohort Study

Low-dose isoflurane stimulates spontaneous breathing. We, therefore, tested the hypothesis that isoflurane compared to propofol sedation for at least 48 h is associated with increased respiratory drive in intensive care patients after sedation stop. All patients in our intensive care unit receiving...

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Autores principales: Müller-Wirtz, Lukas Martin, Grimm, Dustin, Albrecht, Frederic Walter, Fink, Tobias, Volk, Thomas, Meiser, Andreas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9504554/
https://www.ncbi.nlm.nih.gov/pubmed/36143068
http://dx.doi.org/10.3390/jcm11185422
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author Müller-Wirtz, Lukas Martin
Grimm, Dustin
Albrecht, Frederic Walter
Fink, Tobias
Volk, Thomas
Meiser, Andreas
author_facet Müller-Wirtz, Lukas Martin
Grimm, Dustin
Albrecht, Frederic Walter
Fink, Tobias
Volk, Thomas
Meiser, Andreas
author_sort Müller-Wirtz, Lukas Martin
collection PubMed
description Low-dose isoflurane stimulates spontaneous breathing. We, therefore, tested the hypothesis that isoflurane compared to propofol sedation for at least 48 h is associated with increased respiratory drive in intensive care patients after sedation stop. All patients in our intensive care unit receiving at least 48 h of isoflurane or propofol sedation in 2019 were included. The primary outcome was increased respiratory drive over 72 h after sedation stop, defined as an arterial carbon dioxide pressure below 35 mmHg and a base excess more than −2 mmol/L. Secondary outcomes were acid–base balance and ventilatory parameters. We analyzed 64 patients, 23 patients sedated with isoflurane and 41 patients sedated with propofol. Patients sedated with isoflurane were about three times as likely to show increased respiratory drive after sedation stop than those sedated with propofol: adjusted risk ratio [95% confidence interval]: 2.9 [1.3, 6.5], p = 0.010. After sedation stop, tidal volumes were significantly greater and arterial carbon dioxide partial pressures were significantly lower, while respiratory rates did not differ in isoflurane versus propofol-sedated patients. In conclusion, prolonged isoflurane use in intensive care patients is associated with increased respiratory drive after sedation stop. Beneficial effects of isoflurane sedation on respiratory drive may, thus, extend beyond the actual period of sedation.
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spelling pubmed-95045542022-09-24 Increased Respiratory Drive after Prolonged Isoflurane Sedation: A Retrospective Cohort Study Müller-Wirtz, Lukas Martin Grimm, Dustin Albrecht, Frederic Walter Fink, Tobias Volk, Thomas Meiser, Andreas J Clin Med Article Low-dose isoflurane stimulates spontaneous breathing. We, therefore, tested the hypothesis that isoflurane compared to propofol sedation for at least 48 h is associated with increased respiratory drive in intensive care patients after sedation stop. All patients in our intensive care unit receiving at least 48 h of isoflurane or propofol sedation in 2019 were included. The primary outcome was increased respiratory drive over 72 h after sedation stop, defined as an arterial carbon dioxide pressure below 35 mmHg and a base excess more than −2 mmol/L. Secondary outcomes were acid–base balance and ventilatory parameters. We analyzed 64 patients, 23 patients sedated with isoflurane and 41 patients sedated with propofol. Patients sedated with isoflurane were about three times as likely to show increased respiratory drive after sedation stop than those sedated with propofol: adjusted risk ratio [95% confidence interval]: 2.9 [1.3, 6.5], p = 0.010. After sedation stop, tidal volumes were significantly greater and arterial carbon dioxide partial pressures were significantly lower, while respiratory rates did not differ in isoflurane versus propofol-sedated patients. In conclusion, prolonged isoflurane use in intensive care patients is associated with increased respiratory drive after sedation stop. Beneficial effects of isoflurane sedation on respiratory drive may, thus, extend beyond the actual period of sedation. MDPI 2022-09-15 /pmc/articles/PMC9504554/ /pubmed/36143068 http://dx.doi.org/10.3390/jcm11185422 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Müller-Wirtz, Lukas Martin
Grimm, Dustin
Albrecht, Frederic Walter
Fink, Tobias
Volk, Thomas
Meiser, Andreas
Increased Respiratory Drive after Prolonged Isoflurane Sedation: A Retrospective Cohort Study
title Increased Respiratory Drive after Prolonged Isoflurane Sedation: A Retrospective Cohort Study
title_full Increased Respiratory Drive after Prolonged Isoflurane Sedation: A Retrospective Cohort Study
title_fullStr Increased Respiratory Drive after Prolonged Isoflurane Sedation: A Retrospective Cohort Study
title_full_unstemmed Increased Respiratory Drive after Prolonged Isoflurane Sedation: A Retrospective Cohort Study
title_short Increased Respiratory Drive after Prolonged Isoflurane Sedation: A Retrospective Cohort Study
title_sort increased respiratory drive after prolonged isoflurane sedation: a retrospective cohort study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9504554/
https://www.ncbi.nlm.nih.gov/pubmed/36143068
http://dx.doi.org/10.3390/jcm11185422
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