Daume Philipp, Weis Johannes, Bomberg Hagen, Bellgardt Martin, Volk Thomas, Groesdonk Heinrich V, Meiser Andreas
Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Hospital Medical Center, 66421 Homburg, Germany.
Department of Anesthesiology and Intensive Care Medicine, St. Josef Hospital, Katholisches Klinikum Bochum, University Hospital, Ruhr-University of Bochum, 44791 Bochum, Germany.
J Clin Med. 2021 Feb 9;10(4):665. doi: 10.3390/jcm10040665.
In recent years, inhaled sedation has been increasingly used in the intensive care unit (ICU). The aim of this prospective, controlled trial was to compare washout and awakening times after long term sedation with desflurane and isoflurane both administered with the Mirus™ system (TIM GmbH, Koblenz, Germany). Twenty-one consecutive critically ill patients were alternately allocated to the two study groups, obtaining inhaled sedation with either desflurane or isoflurane. After 24 h study sedation, anesthetic washout curves were recorded, and a standardized wake-up test was performed. The primary outcome measure was the time required to decrease the endtidal concentration to 50% (T50%). Secondary outcome measures were T80% and awakening times (all extremities moved, RASS -2). Decrement times (min) (desflurane versus isoflurane, median (1st quartile-3rd quartile)) (T50%: 0.3 (0.3-0.4) vs. 1.3 (0.4-2.3), log-rank test P = 0.002; P80%: 2.5 (2-5.9) vs. 12.1 (5.1-20.2), P = 0.022) and awakening times (to RASS -2: 7.5 (5.5-8.8) vs. 41.0 (24.5-43.0), P = 0.007; all extremities moved: 5.0 (4.0-8.5) vs. 13.0 (8.0-41.25), P = 0.037) were significantly shorter after desflurane compared to isoflurane. The use of desflurane with the Mirus™ system significantly shortens the washout times and leads to faster awakening after sedation of critically ill patients.
近年来，吸入镇静在重症监护病房（ICU）中的应用越来越广泛。这项前瞻性对照试验的目的是比较使用Mirus™系统（德国科布伦茨的TIM GmbH公司）给予地氟烷和异氟烷进行长期镇静后的清除时间和苏醒时间。连续21例重症患者被交替分配到两个研究组，分别接受地氟烷或异氟烷吸入镇静。在进行24小时的研究镇静后，记录麻醉清除曲线，并进行标准化的苏醒测试。主要观察指标是将呼气末浓度降至50%（T50%）所需的时间。次要观察指标是T80%和苏醒时间（四肢均能活动，RASS -2）。与异氟烷相比，地氟烷的递减时间（分钟）（地氟烷与异氟烷，中位数（第1四分位数-第3四分位数））（T50%：0.3（0.3 - 0.4）对1.3（0.4 - 2.3），对数秩检验P = 0.002；P80%：2.5（2 - 5.9）对12.1（5.1 - 20.2），P = 0.022）和苏醒时间（至RASS -2：7.5（5.5 - 8.8）对41.0（24.5 - 43.0），P = 0.007；四肢均能活动：5.0（4.0 - 8.5）对13.0（8.0 - 41.25），P = 0.037）明显更短。使用Mirus™系统给予地氟烷可显著缩短清除时间，并使重症患者在镇静后更快苏醒。
