Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review
Purpose In this retrospective study, we compared inhaled sedation with isoflurane to intravenous propofol in invasively ventilated COVID-19 patients with ARDS (Acute Respiratory Distress Syndrome). Methods Charts of all 20 patients with COVID-19 ARDS admitted to the ICU of a German University Hospit...
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| Veröffentlicht in: | Journal of anesthesia 2021-10, Vol.35 (5), p.625-632 |
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| creator | Kermad, Azzeddine Speltz, Jacques Danziger, Guy Mertke, Thilo Bals, Robert Volk, Thomas Lepper, Philipp M. Meiser, Andreas |
| description | Purpose
In this retrospective study, we compared inhaled sedation with isoflurane to intravenous propofol in invasively ventilated COVID-19 patients with ARDS (Acute Respiratory Distress Syndrome).
Methods
Charts of all 20 patients with COVID-19 ARDS admitted to the ICU of a German University Hospital during the first wave of the pandemic between 22/03/2020 and 21/04/2020 were reviewed. Among screened 333 days, isoflurane was used in 97 days, while in 187 days, propofol was used for 12 h or more. The effect and dose of these two sedatives were compared. Mixed sedation days were excluded.
Results
Patients’ age (median [interquartile range]) was 64 (60–68) years. They were invasively ventilated for 36 [21–50] days. End-tidal isoflurane concentrations were high (0.96 ± 0.41 Vol %); multiple linear regression yielded the ratio (isoflurane infusion rate)/(minute ventilation) as the single best predictor. Infusion rates were decreased under ECMO (3.5 ± 1.4 versus 7.1 ± 3.2 ml∙h
−1
;
p
|
| doi_str_mv | 10.1007/s00540-021-02960-6 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8225486</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A676610154</galeid><sourcerecordid>A676610154</sourcerecordid><originalsourceid>FETCH-LOGICAL-c602t-a0d4c1bbabf72536f32b7d5d8615ee91355ae055f9685db787268c7a53bddd743</originalsourceid><addsrcrecordid>eNp9ks1q3DAQx0VpaLZpX6CHIujZqWRZsnwphO1XIJBL0quQpdFGwZZcybshtz5En7BPUm3dhgSWIsTAzG_-mtEMQm8oOaWEtO8zIbwhFalpuZ0glXiGVrRhspKMd8_RinSUVVIIeYxe5nxLCBGUshfomDVUdEzUK_R9HcdJJ59jwNHhYt2wTToA1sHiKcUpujjgDFbPvjA-YJP87I0ehnvshwGvL7-df6xoh6dCQJjzrx8_NU4wp5gnMLPfATY3Os3Ft_Nw9wodOT1keP3XnqDrz5-u1l-ri8sv5-uzi8oIUs-VJrYxtO9179qaM-FY3beWWykoByiNca6BcO46IbntW9nWQppWc9Zba9uGnaAPi-607UewppSW9KCm5Eed7lXUXj2NBH-jNnGnZF3zRooi8G4R2OgBlA8uFsyMPht1JlohKKF8_0x1gNpAgKIZAzhf3E_40wN8ORZGbw4m1EuCKR-aE7iHFihR-z1Qyx6osgfqzx6ofe1vHzf_kPJv8AVgC5BLKGwgqdu4TaEM5H-yvwGzucAd</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Kermad, Azzeddine ; Speltz, Jacques ; Danziger, Guy ; Mertke, Thilo ; Bals, Robert ; Volk, Thomas ; Lepper, Philipp M. ; Meiser, Andreas</creator><creatorcontrib>Kermad, Azzeddine ; Speltz, Jacques ; Danziger, Guy ; Mertke, Thilo ; Bals, Robert ; Volk, Thomas ; Lepper, Philipp M. ; Meiser, Andreas</creatorcontrib><description>Purpose
In this retrospective study, we compared inhaled sedation with isoflurane to intravenous propofol in invasively ventilated COVID-19 patients with ARDS (Acute Respiratory Distress Syndrome).
Methods
Charts of all 20 patients with COVID-19 ARDS admitted to the ICU of a German University Hospital during the first wave of the pandemic between 22/03/2020 and 21/04/2020 were reviewed. Among screened 333 days, isoflurane was used in 97 days, while in 187 days, propofol was used for 12 h or more. The effect and dose of these two sedatives were compared. Mixed sedation days were excluded.
Results
Patients’ age (median [interquartile range]) was 64 (60–68) years. They were invasively ventilated for 36 [21–50] days. End-tidal isoflurane concentrations were high (0.96 ± 0.41 Vol %); multiple linear regression yielded the ratio (isoflurane infusion rate)/(minute ventilation) as the single best predictor. Infusion rates were decreased under ECMO (3.5 ± 1.4 versus 7.1 ± 3.2 ml∙h
−1
;
p
< 0.001). In five patients, the maximum recommended dose of propofol of 4 mg∙hour
−1
∙kg
−1
ABW was exceeded on several days. On isoflurane compared to propofol days, neuro-muscular blocking agents (NMBAs) were used less frequently (11% versus 21%;
p
< 0.05), as were co-sedatives (7% versus 31%,
p
< 0.001); daily opioid doses were lower (720 [720–960] versus 1080 [720–1620] mg morphine equivalents,
p
< 0.001); and RASS scores indicated deeper levels of sedation (− 4.0 [− 4.0 to − 3.0] versus − 3.0 [− 3.6 to − 2.5];
p
< 0.01).
Conclusion
Isoflurane provided sufficient sedation with less NMBAs, less polypharmacy and lower opioid doses compared to propofol. High doses of both drugs were needed in severely ill COVID-19 patients.</description><identifier>ISSN: 0913-8668</identifier><identifier>EISSN: 1438-8359</identifier><identifier>DOI: 10.1007/s00540-021-02960-6</identifier><identifier>PMID: 34169362</identifier><language>eng</language><publisher>Singapore: Springer Singapore</publisher><subject>Acute respiratory distress syndrome ; Anesthesiology ; Comparative analysis ; Conscious Sedation ; COVID-19 ; Critical Care Medicine ; Critical Illness ; Dexmedetomidine ; Emergency Medicine ; Epidemics ; Germany ; Halides ; Humans ; Hypnotics and Sedatives - adverse effects ; Intensive ; Intensive Care Units ; Isoflurane - adverse effects ; Medicine ; Medicine & Public Health ; Middle Aged ; Original ; Original Article ; Pain Medicine ; Phenols ; Propofol ; Remifentanil ; Respiration, Artificial ; Retrospective Studies ; SARS-CoV-2 ; Sufentanil ; Sweden ; United Kingdom</subject><ispartof>Journal of anesthesia, 2021-10, Vol.35 (5), p.625-632</ispartof><rights>The Author(s) 2021</rights><rights>2021. The Author(s).</rights><rights>COPYRIGHT 2021 Springer</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c602t-a0d4c1bbabf72536f32b7d5d8615ee91355ae055f9685db787268c7a53bddd743</citedby><cites>FETCH-LOGICAL-c602t-a0d4c1bbabf72536f32b7d5d8615ee91355ae055f9685db787268c7a53bddd743</cites><orcidid>0000-0001-7930-0062</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00540-021-02960-6$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00540-021-02960-6$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34169362$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kermad, Azzeddine</creatorcontrib><creatorcontrib>Speltz, Jacques</creatorcontrib><creatorcontrib>Danziger, Guy</creatorcontrib><creatorcontrib>Mertke, Thilo</creatorcontrib><creatorcontrib>Bals, Robert</creatorcontrib><creatorcontrib>Volk, Thomas</creatorcontrib><creatorcontrib>Lepper, Philipp M.</creatorcontrib><creatorcontrib>Meiser, Andreas</creatorcontrib><title>Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review</title><title>Journal of anesthesia</title><addtitle>J Anesth</addtitle><addtitle>J Anesth</addtitle><description>Purpose
In this retrospective study, we compared inhaled sedation with isoflurane to intravenous propofol in invasively ventilated COVID-19 patients with ARDS (Acute Respiratory Distress Syndrome).
Methods
Charts of all 20 patients with COVID-19 ARDS admitted to the ICU of a German University Hospital during the first wave of the pandemic between 22/03/2020 and 21/04/2020 were reviewed. Among screened 333 days, isoflurane was used in 97 days, while in 187 days, propofol was used for 12 h or more. The effect and dose of these two sedatives were compared. Mixed sedation days were excluded.
Results
Patients’ age (median [interquartile range]) was 64 (60–68) years. They were invasively ventilated for 36 [21–50] days. End-tidal isoflurane concentrations were high (0.96 ± 0.41 Vol %); multiple linear regression yielded the ratio (isoflurane infusion rate)/(minute ventilation) as the single best predictor. Infusion rates were decreased under ECMO (3.5 ± 1.4 versus 7.1 ± 3.2 ml∙h
−1
;
p
< 0.001). In five patients, the maximum recommended dose of propofol of 4 mg∙hour
−1
∙kg
−1
ABW was exceeded on several days. On isoflurane compared to propofol days, neuro-muscular blocking agents (NMBAs) were used less frequently (11% versus 21%;
p
< 0.05), as were co-sedatives (7% versus 31%,
p
< 0.001); daily opioid doses were lower (720 [720–960] versus 1080 [720–1620] mg morphine equivalents,
p
< 0.001); and RASS scores indicated deeper levels of sedation (− 4.0 [− 4.0 to − 3.0] versus − 3.0 [− 3.6 to − 2.5];
p
< 0.01).
Conclusion
Isoflurane provided sufficient sedation with less NMBAs, less polypharmacy and lower opioid doses compared to propofol. High doses of both drugs were needed in severely ill COVID-19 patients.</description><subject>Acute respiratory distress syndrome</subject><subject>Anesthesiology</subject><subject>Comparative analysis</subject><subject>Conscious Sedation</subject><subject>COVID-19</subject><subject>Critical Care Medicine</subject><subject>Critical Illness</subject><subject>Dexmedetomidine</subject><subject>Emergency Medicine</subject><subject>Epidemics</subject><subject>Germany</subject><subject>Halides</subject><subject>Humans</subject><subject>Hypnotics and Sedatives - adverse effects</subject><subject>Intensive</subject><subject>Intensive Care Units</subject><subject>Isoflurane - adverse effects</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Original Article</subject><subject>Pain Medicine</subject><subject>Phenols</subject><subject>Propofol</subject><subject>Remifentanil</subject><subject>Respiration, Artificial</subject><subject>Retrospective Studies</subject><subject>SARS-CoV-2</subject><subject>Sufentanil</subject><subject>Sweden</subject><subject>United Kingdom</subject><issn>0913-8668</issn><issn>1438-8359</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9ks1q3DAQx0VpaLZpX6CHIujZqWRZsnwphO1XIJBL0quQpdFGwZZcybshtz5En7BPUm3dhgSWIsTAzG_-mtEMQm8oOaWEtO8zIbwhFalpuZ0glXiGVrRhspKMd8_RinSUVVIIeYxe5nxLCBGUshfomDVUdEzUK_R9HcdJJ59jwNHhYt2wTToA1sHiKcUpujjgDFbPvjA-YJP87I0ehnvshwGvL7-df6xoh6dCQJjzrx8_NU4wp5gnMLPfATY3Os3Ft_Nw9wodOT1keP3XnqDrz5-u1l-ri8sv5-uzi8oIUs-VJrYxtO9179qaM-FY3beWWykoByiNca6BcO46IbntW9nWQppWc9Zba9uGnaAPi-607UewppSW9KCm5Eed7lXUXj2NBH-jNnGnZF3zRooi8G4R2OgBlA8uFsyMPht1JlohKKF8_0x1gNpAgKIZAzhf3E_40wN8ORZGbw4m1EuCKR-aE7iHFihR-z1Qyx6osgfqzx6ofe1vHzf_kPJv8AVgC5BLKGwgqdu4TaEM5H-yvwGzucAd</recordid><startdate>20211001</startdate><enddate>20211001</enddate><creator>Kermad, Azzeddine</creator><creator>Speltz, Jacques</creator><creator>Danziger, Guy</creator><creator>Mertke, Thilo</creator><creator>Bals, Robert</creator><creator>Volk, Thomas</creator><creator>Lepper, Philipp M.</creator><creator>Meiser, Andreas</creator><general>Springer Singapore</general><general>Springer</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7930-0062</orcidid></search><sort><creationdate>20211001</creationdate><title>Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review</title><author>Kermad, Azzeddine ; Speltz, Jacques ; Danziger, Guy ; Mertke, Thilo ; Bals, Robert ; Volk, Thomas ; Lepper, Philipp M. ; Meiser, Andreas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c602t-a0d4c1bbabf72536f32b7d5d8615ee91355ae055f9685db787268c7a53bddd743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acute respiratory distress syndrome</topic><topic>Anesthesiology</topic><topic>Comparative analysis</topic><topic>Conscious Sedation</topic><topic>COVID-19</topic><topic>Critical Care Medicine</topic><topic>Critical Illness</topic><topic>Dexmedetomidine</topic><topic>Emergency Medicine</topic><topic>Epidemics</topic><topic>Germany</topic><topic>Halides</topic><topic>Humans</topic><topic>Hypnotics and Sedatives - adverse effects</topic><topic>Intensive</topic><topic>Intensive Care Units</topic><topic>Isoflurane - adverse effects</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Original Article</topic><topic>Pain Medicine</topic><topic>Phenols</topic><topic>Propofol</topic><topic>Remifentanil</topic><topic>Respiration, Artificial</topic><topic>Retrospective Studies</topic><topic>SARS-CoV-2</topic><topic>Sufentanil</topic><topic>Sweden</topic><topic>United Kingdom</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kermad, Azzeddine</creatorcontrib><creatorcontrib>Speltz, Jacques</creatorcontrib><creatorcontrib>Danziger, Guy</creatorcontrib><creatorcontrib>Mertke, Thilo</creatorcontrib><creatorcontrib>Bals, Robert</creatorcontrib><creatorcontrib>Volk, Thomas</creatorcontrib><creatorcontrib>Lepper, Philipp M.</creatorcontrib><creatorcontrib>Meiser, Andreas</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kermad, Azzeddine</au><au>Speltz, Jacques</au><au>Danziger, Guy</au><au>Mertke, Thilo</au><au>Bals, Robert</au><au>Volk, Thomas</au><au>Lepper, Philipp M.</au><au>Meiser, Andreas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review</atitle><jtitle>Journal of anesthesia</jtitle><stitle>J Anesth</stitle><addtitle>J Anesth</addtitle><date>2021-10-01</date><risdate>2021</risdate><volume>35</volume><issue>5</issue><spage>625</spage><epage>632</epage><pages>625-632</pages><issn>0913-8668</issn><eissn>1438-8359</eissn><abstract>Purpose
In this retrospective study, we compared inhaled sedation with isoflurane to intravenous propofol in invasively ventilated COVID-19 patients with ARDS (Acute Respiratory Distress Syndrome).
Methods
Charts of all 20 patients with COVID-19 ARDS admitted to the ICU of a German University Hospital during the first wave of the pandemic between 22/03/2020 and 21/04/2020 were reviewed. Among screened 333 days, isoflurane was used in 97 days, while in 187 days, propofol was used for 12 h or more. The effect and dose of these two sedatives were compared. Mixed sedation days were excluded.
Results
Patients’ age (median [interquartile range]) was 64 (60–68) years. They were invasively ventilated for 36 [21–50] days. End-tidal isoflurane concentrations were high (0.96 ± 0.41 Vol %); multiple linear regression yielded the ratio (isoflurane infusion rate)/(minute ventilation) as the single best predictor. Infusion rates were decreased under ECMO (3.5 ± 1.4 versus 7.1 ± 3.2 ml∙h
−1
;
p
< 0.001). In five patients, the maximum recommended dose of propofol of 4 mg∙hour
−1
∙kg
−1
ABW was exceeded on several days. On isoflurane compared to propofol days, neuro-muscular blocking agents (NMBAs) were used less frequently (11% versus 21%;
p
< 0.05), as were co-sedatives (7% versus 31%,
p
< 0.001); daily opioid doses were lower (720 [720–960] versus 1080 [720–1620] mg morphine equivalents,
p
< 0.001); and RASS scores indicated deeper levels of sedation (− 4.0 [− 4.0 to − 3.0] versus − 3.0 [− 3.6 to − 2.5];
p
< 0.01).
Conclusion
Isoflurane provided sufficient sedation with less NMBAs, less polypharmacy and lower opioid doses compared to propofol. High doses of both drugs were needed in severely ill COVID-19 patients.</abstract><cop>Singapore</cop><pub>Springer Singapore</pub><pmid>34169362</pmid><doi>10.1007/s00540-021-02960-6</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-7930-0062</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0913-8668 |
| ispartof | Journal of anesthesia, 2021-10, Vol.35 (5), p.625-632 |
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| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Acute respiratory distress syndrome Anesthesiology Comparative analysis Conscious Sedation COVID-19 Critical Care Medicine Critical Illness Dexmedetomidine Emergency Medicine Epidemics Germany Halides Humans Hypnotics and Sedatives - adverse effects Intensive Intensive Care Units Isoflurane - adverse effects Medicine Medicine & Public Health Middle Aged Original Original Article Pain Medicine Phenols Propofol Remifentanil Respiration, Artificial Retrospective Studies SARS-CoV-2 Sufentanil Sweden United Kingdom |
| title | Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review |
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