Rand Axel, Zahn Peter K, Schildhauer Thomas A, Waydhas Christian, Hamsen Uwe
BG Universitätsklinikum Bergmannsheil, Klinik für Anästhesiologie, Intensiv-, Palliativ- und Schmerzmedizin, Bochum, Germany.
BG Universitätsklinikum Bergmannsheil, Klinik und Poliklinik für Chirurgie, Bochum, Germany.
J Artif Organs. 2018 Jun;21(2):201-205. doi: 10.1007/s10047-018-1030-9. Epub 2018 Mar 5.
Inhalative sedation is an emerging method for long-term sedation in intensive care therapy. There is evidence that it is easy to control and may be beneficial compared to intravenous sedation. Yet little is known about the use in patients with compromised lung function. In this retrospective analysis, we searched files of patients receiving inhalative sedation under venovenous extracorporeal membrane oxygenator (vv-ECMO) support due to lung failure.
After ethical approval, we performed a retrospective analysis of patients receiving vv-ECMO support and inhalative sedation in the surgical ICU in 2015. Isoflurane was administered via the AnaConDa®-system. Sedation was tested using Richmond Agitation and Sedation scale (RASS).
7 patients were identified. Median age was 50 years (26/70 years). All were male. Median ECMO runtime was 129 h (37/1008 h) and the survival rate was 57.9%. Dose of isoflurane was 1.7 ml/h (0.8 / 4.0 ml/h) resulting in expiratory concentrations of 0.8 Vol% (0.3/1.8 Vol%), inspiratory of 0.6 Vol% (0.1/1.4 Vol%). Higher concentrations of isoflurane were associated with increased depth of sedation (expiratory p = 0.016; inspiratory p = 0.027; averaged p = 0.015). With tidal volume below 350 ml, association was still present for expiratory and averaged concentrations of isoflurane (expiratory p = 0.031; inspiratory p = 0.082; average p = 0.039).
This is the first study that shows that inhalative concentrations of isoflurane are associated with depth of sedation in patients with lung failure. We were able to show that even with major impacts in lung mechanics and function targeted sedation with volatile anaesthetics is feasible and dose-response relationship appears to exist.
吸入性镇静是重症监护治疗中长期镇静的一种新兴方法。有证据表明，与静脉镇静相比，它易于控制且可能有益。然而，对于肺功能受损患者的使用情况知之甚少。在这项回顾性分析中，我们检索了因肺衰竭在静脉-静脉体外膜肺氧合（vv-ECMO）支持下接受吸入性镇静患者的病历。
经伦理批准后，我们对2015年在外科重症监护病房接受vv-ECMO支持和吸入性镇静的患者进行了回顾性分析。异氟烷通过AnaConDa®系统给药。使用里士满躁动和镇静量表（RASS）测试镇静效果。
共确定7例患者。中位年龄为50岁（26/70岁）。均为男性。ECMO中位运行时间为129小时（37/1008小时），生存率为57.9%。异氟烷剂量为1.7毫升/小时（0.8/4.0毫升/小时），呼气浓度为0.8%（0.3/1.8%），吸气浓度为0.6%（0.1/1.4%）。较高浓度的异氟烷与镇静深度增加相关（呼气p = 0.016；吸气p = 0.027；平均p = 0.015）。当潮气量低于350毫升时，异氟烷呼气浓度和平均浓度仍存在相关性（呼气p = 0.031；吸气p = 0.082；平均p = 0.039）。
这是第一项表明肺衰竭患者吸入异氟烷浓度与镇静深度相关的研究。我们能够证明，即使对肺力学和功能有重大影响，使用挥发性麻醉剂进行目标镇静也是可行的，并且似乎存在剂量-反应关系。
