Department of Anesthesiology, Intensive Care Medicine and Palliative Care Medicine, Carl-Thiem-Hospital, Cottbus, Germany; Department of Anesthesiology and Surgical Intensive Care, University Hospital Halle (Saale), Halle (Saale), Germany.
Department of Anesthesiology and Surgical Intensive Care, University Hospital Halle (Saale), Halle (Saale), Germany.
J Crit Care. 2023 Apr;74:154251. doi: 10.1016/j.jcrc.2022.154251. Epub 2023 Jan 12.
Volatile anesthetics are used more commonly for sedation in the intensive-care-unit (ICU). However, evidence for long-term use remains low. We therefore conducted a randomized-controlled trial comparing sevoflurane with intravenous sedation with particular focus on efficacy and safety.
In this prospective, randomized-controlled phase-IIb monocentric clinical-trial ICU patients requiring at least 48 h of sedation were randomized to receive sevoflurane (S) or propofol/midazolam (P). Sedation quality was monitored using the Richmond-Agitation-Sedation-Scale. Following termination of sedation, the time to spontaneous breathing and extubation, opioid consumption, hemodynamics, ICU and hospital length of stay (LOS) and adverse events were recorded.
79 patients were eligible to randomization. Sedation quality was comparable between sevoflurane (n = 39) and propofol (n = 40). However, the use of sevoflurane lead to a reduction in time to spontaneous breathing (26 min vs. 375 min, P < 0.001). Patients sedated with propofol had lower opioid requirements (remifentanil:400 μg/h vs. 500 μg/h, P = 0.007; sufentanil:40 μg/h vs. 30 μg/h, P = 0.007) while hemodynamics, LOS or the occurrence of adverse events did not differ.
ICU patients sedated with sevoflurane >48 h may return to spontaneous breathing faster, while the quality of sedation is comparable to a propofol-based sedation regime. Sevoflurane might be considered to be safe for long-term sedation in this patient population, while being non-inferior compared to propofol.
在重症监护病房（ICU）中，挥发性麻醉剂更常用于镇静。然而，长期使用的证据仍然不足。因此，我们进行了一项随机对照试验，比较七氟醚与静脉镇静，特别关注疗效和安全性。
在这项前瞻性、随机对照的 IIb 期单中心临床试验中，需要至少 48 小时镇静的 ICU 患者被随机分为接受七氟醚（S）或丙泊酚/咪达唑仑（P）镇静组。镇静质量使用 Richmond 躁动镇静评分监测。镇静停止后，记录自主呼吸和拔管时间、阿片类药物消耗、血流动力学、ICU 和住院时间（LOS）以及不良事件。
79 名患者符合随机分组条件。七氟醚（n=39）和丙泊酚（n=40）镇静的镇静质量相当。然而，使用七氟醚可缩短自主呼吸恢复时间（26 分钟 vs. 375 分钟，P<0.001）。接受丙泊酚镇静的患者阿片类药物需求较低（瑞芬太尼：400μg/h vs. 500μg/h，P=0.007；舒芬太尼：40μg/h vs. 30μg/h，P=0.007），而血流动力学、LOS 或不良事件的发生无差异。
接受七氟醚镇静超过 48 小时的 ICU 患者可能更快恢复自主呼吸，而镇静质量与丙泊酚镇静方案相当。七氟醚在该患者人群中可能被认为是安全的长期镇静剂，与丙泊酚相比非劣效。
