Flinspach Armin Niklas, Zacharowski Kai, Ioanna Deligiannis, Adam Elisabeth Hannah
All authors: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt/Main, Germany.
Crit Care Explor. 2020 Oct 21;2(10):e0256. doi: 10.1097/CCE.0000000000000256. eCollection 2020 Oct.
The ongoing coronavirus pandemic is challenging, especially in severely affected patients who require intubation and sedation. Although the potential benefits of sedation with volatile anesthetics in coronavirus disease 2019 patients are currently being discussed, the use of isoflurane in patients with coronavirus disease 2019-induced acute respiratory distress syndrome has not yet been reported.
We performed a retrospective analysis of critically ill patients with hypoxemic respiratory failure requiring mechanical ventilation.
The study was conducted with patients admitted between April 4 and May 15, 2020 to our ICU.
We included five patients who were previously diagnosed with severe acute respiratory syndrome coronavirus 2 infection.
Even with high doses of several IV sedatives, the targeted level of sedation could not be achieved. Therefore, the sedation regimen was switched to inhalational isoflurane. Clinical data were recorded using a patient data management system. We recorded demographical data, laboratory results, ventilation variables, sedative dosages, sedation level, prone positioning, duration of volatile sedation and outcomes.
MEASUREMENTS & MAIN RESULTS: Mean age (four men, one women) was 53.0 (± 12.7) years. The mean duration of isoflurane sedation was 103.2 (± 66.2) hours. Our data demonstrate a substantial improvement in the oxygenation ratio when using isoflurane sedation. Deep sedation as assessed by the Richmond Agitation and Sedation Scale was rapidly and closely controlled in all patients, and the subsequent discontinuation of IV sedation was possible within the first 30 minutes. No adverse events were detected.
Our findings demonstrate the feasibility of isoflurane sedation in five patients suffering from severe coronavirus disease 2019 infection. Volatile isoflurane was able to achieve the required deep sedation and reduced the need for IV sedation.
当前的冠状病毒大流行具有挑战性，对于需要插管和镇静的重症患者尤其如此。尽管目前正在讨论挥发性麻醉剂用于2019冠状病毒病患者镇静的潜在益处，但异氟烷用于2019冠状病毒病所致急性呼吸窘迫综合征患者的情况尚未见报道。
我们对需要机械通气的低氧性呼吸衰竭重症患者进行了回顾性分析。
本研究纳入了2020年4月4日至5月15日入住我们重症监护病房的患者。
我们纳入了5例先前诊断为严重急性呼吸综合征冠状病毒2感染的患者。
即使使用了高剂量的几种静脉镇静剂，仍无法达到目标镇静水平。因此，镇静方案改为吸入异氟烷。使用患者数据管理系统记录临床数据。我们记录了人口统计学数据、实验室检查结果、通气变量、镇静剂剂量、镇静水平、俯卧位、挥发性镇静持续时间和结局。
平均年龄（4名男性，1名女性）为53.0（±12.7）岁。异氟烷镇静的平均持续时间为103.2（±66.2）小时。我们的数据表明，使用异氟烷镇静时氧合比有显著改善。根据里士满躁动和镇静量表评估的深度镇静在所有患者中均得到快速且严格的控制，随后在最初30分钟内即可停用静脉镇静剂。未检测到不良事件。
我们的研究结果表明，异氟烷镇静用于5例严重2019冠状病毒病感染患者是可行的。挥发性异氟烷能够达到所需的深度镇静，并减少了静脉镇静的需求。
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