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Müller-Wirtz LM, Becher T, Günther U, Bellgardt M, Sackey P, Volk T, Meiser A. Ventilatory Effects of Isoflurane Sedation via the Sedaconda ACD-S versus ACD-L: A Substudy of a Randomized Trial. J Clin Med 2023; 12:jcm12093314. [PMID: 37176754 PMCID: PMC10179426 DOI: 10.3390/jcm12093314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
Devices used to deliver inhaled sedation increase dead space ventilation. We therefore compared ventilatory effects among isoflurane sedation via the Sedaconda ACD-S (internal volume: 50 mL), isoflurane sedation via the Sedaconda ACD-L (100 mL), and propofol sedation with standard mechanical ventilation with heat and moisture exchangers (HME). This is a substudy of a randomized trial that compared inhaled isoflurane sedation via the ACD-S or ACD-L to intravenous propofol sedation in 301 intensive care patients. Data from the first 24 h after study inclusion were analyzed using linear mixed models. Primary outcome was minute ventilation. Secondary outcomes were tidal volume, respiratory rate, arterial carbon dioxide pressure, and isoflurane consumption. In total, 151 patients were randomized to propofol and 150 to isoflurane sedation; 64 patients received isoflurane via the ACD-S and 86 patients via the ACD-L. While use of the ACD-L was associated with higher minute ventilation (average difference (95% confidence interval): 1.3 (0.7, 1.8) L/min, p < 0.001), higher tidal volumes (44 (16, 72) mL, p = 0.002), higher respiratory rates (1.2 (0.1, 2.2) breaths/min, p = 0.025), and higher arterial carbon dioxide pressures (3.4 (1.2, 5.6) mmHg, p = 0.002), use of the ACD-S did not significantly affect ventilation compared to standard mechanical ventilation and sedation. Isoflurane consumption was slightly less with the ACD-L compared to the ACD-S (-0.7 (-1.3, 0.1) mL/h, p = 0.022). The Sedaconda ACD-S compared to the ACD-L is associated with reduced minute ventilation and does not significantly affect ventilation compared to a standard mechanical ventilation and sedation setting. The smaller ACD-S is therefore the device of choice to minimize impact on ventilation, especially in patients with a limited ability to compensate (e.g., COPD patients). Volatile anesthetic consumption is slightly higher with the ACD-S compared to the ACD-L.
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Affiliation(s)
- Lukas M Müller-Wirtz
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, 66421 Homburg, Germany
- Outcomes Research Consortium, Cleveland, OH 44195, USA
| | - Tobias Becher
- Department of Anesthesiology and Intensive Care Medicine, Campus Kiel, University Medical Center Schleswig-Holstein, 24118 Kiel, Germany
| | - Ulf Günther
- Department of Anaesthesiology, Intensive Care, Emergency Medicine, Pain Therapy, University Hospital Oldenburg, 26133 Oldenburg, Germany
| | - Martin Bellgardt
- Department of Anaesthesiology and Intensive Care Medicine, St. Josef-Hospital, University Hospital of the Ruhr-University Bochum, 44780 Bochum, Germany
| | - Peter Sackey
- Unit of Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institute, 17177 Stockholm, Sweden
- Sedana Medical AB, 18232 Danderyd, Sweden
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, 66421 Homburg, Germany
- Outcomes Research Consortium, Cleveland, OH 44195, USA
| | - Andreas Meiser
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, 66421 Homburg, Germany
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Blondonnet R, Simand LA, Vidal P, Borao L, Bourguignon N, Morand D, Bernard L, Roszyk L, Audard J, Godet T, Monsel A, Garnier M, Quesnel C, Bazin JE, Sapin V, Bastarache JA, Ware LB, Hughes CG, Pandharipande PP, Ely EW, Futier E, Pereira B, Constantin JM, Jabaudon M. Design and Rationale of the Sevoflurane for Sedation in Acute Respiratory Distress Syndrome (SESAR) Randomized Controlled Trial. J Clin Med 2022; 11:2796. [PMID: 35628922 PMCID: PMC9147018 DOI: 10.3390/jcm11102796] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023] Open
Abstract
Preclinical studies have shown that volatile anesthetics may have beneficial effects on injured lungs, and pilot clinical data support improved arterial oxygenation, attenuated inflammation, and decreased lung epithelial injury in patients with acute respiratory distress syndrome (ARDS) receiving inhaled sevoflurane compared to intravenous midazolam. Whether sevoflurane is effective in improving clinical outcomes among patients with ARDS is unknown, and the benefits and risks of inhaled sedation in ARDS require further evaluation. Here, we describe the SESAR (Sevoflurane for Sedation in ARDS) trial designed to address this question. SESAR is a two-arm, investigator-initiated, multicenter, prospective, randomized, stratified, parallel-group clinical trial with blinded outcome assessment designed to test the efficacy of sedation with sevoflurane compared to intravenous propofol in patients with moderate to severe ARDS. The primary outcome is the number of days alive and off the ventilator at 28 days, considering death as a competing event, and the key secondary outcome is 90 day survival. The planned enrollment is 700 adult participants at 37 French academic and non-academic centers. Safety and long-term outcomes will be evaluated, and biomarker measurements will help better understand mechanisms of action. The trial is funded by the French Ministry of Health, the European Society of Anaesthesiology, and Sedana Medical.
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Affiliation(s)
- Raiko Blondonnet
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
- iGReD, Université Clermont Auvergne, CNRS, INSERM, 63000 Clermont-Ferrand, France; (L.R.); (V.S.)
| | - Laure-Anne Simand
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Perine Vidal
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Lucile Borao
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Nathalie Bourguignon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Dominique Morand
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Lise Bernard
- Department of Clinical Research and Temporary Authorization, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Laurence Roszyk
- iGReD, Université Clermont Auvergne, CNRS, INSERM, 63000 Clermont-Ferrand, France; (L.R.); (V.S.)
- Department of Medical Biochemistry and Molecular Genetics, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Jules Audard
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Thomas Godet
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Antoine Monsel
- Department of Anesthesiology and Critical Care, GRC 29, DMU DREAM, Pitié-Salpêtrière Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; (A.M.); (J.-M.C.)
| | - Marc Garnier
- Department of Anesthesiology and Critical Care Medicine, DMU DREAM, Saint-Antoine University Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France;
| | - Christophe Quesnel
- Department of Anesthesiology and Critical Care Medicine, DMU DREAM, Tenon University Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75020 Paris, France;
| | - Jean-Etienne Bazin
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
| | - Vincent Sapin
- iGReD, Université Clermont Auvergne, CNRS, INSERM, 63000 Clermont-Ferrand, France; (L.R.); (V.S.)
- Department of Medical Biochemistry and Molecular Genetics, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Julie A. Bastarache
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (J.A.B.); (L.B.W.); (E.W.E.)
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN 37232, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lorraine B. Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (J.A.B.); (L.B.W.); (E.W.E.)
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Christopher G. Hughes
- Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (C.G.H.); (P.P.P.)
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- Anesthesia Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN 37212, USA
| | - Pratik P. Pandharipande
- Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (C.G.H.); (P.P.P.)
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- Anesthesia Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN 37212, USA
| | - E. Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (J.A.B.); (L.B.W.); (E.W.E.)
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN 37212, USA
| | - Emmanuel Futier
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
- iGReD, Université Clermont Auvergne, CNRS, INSERM, 63000 Clermont-Ferrand, France; (L.R.); (V.S.)
| | - Bruno Pereira
- Biostatistics and Data Management Unit, Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Jean-Michel Constantin
- Department of Anesthesiology and Critical Care, GRC 29, DMU DREAM, Pitié-Salpêtrière Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France; (A.M.); (J.-M.C.)
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (R.B.); (L.-A.S.); (P.V.); (L.B.); (N.B.); (D.M.); (J.A.); (T.G.); (J.-E.B.); (E.F.)
- iGReD, Université Clermont Auvergne, CNRS, INSERM, 63000 Clermont-Ferrand, France; (L.R.); (V.S.)
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Bailly P, Egreteau PY, Ehrmann S, Thille AW, Guitton C, Grillet G, Reizine F, Huet O, Jaber S, Nowak E, L'her E. Inased (inhaled sedation in ICU) trial protocol: a multicentre randomised open-label trial. BMJ Open 2021; 11:e042284. [PMID: 33608400 PMCID: PMC7896597 DOI: 10.1136/bmjopen-2020-042284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The use of sedation in intensive care units (ICUs) is necessary and ubiquitous. The impact of sedation strategy on outcome, particularly when delivered early after initiation of mechanical ventilation, is unknown. Evidence is increasing that volatile anaesthetic agents could be associated with better outcome. Their use in delirium prevention is unknown. METHODS AND ANALYSIS This study is an investigator-initiated, prospective, multicentre, two-arm, randomised, control, open-trial comparing inhaled sedation strategy versus intravenous sedation strategy in mechanically ventilated patients in ICU. Two hundred and fifty patients will be randomly assigned to the intravenous sedation group or inhaled sedation group, with a 1:1 ratio in two groups according to the sedation strategy. The primary outcome is the occurrence of delirium assessed using two times a day confusion assessment method for the ICU (CAM-ICU). Secondary outcomes include cognitive and functional outcomes at 3 and 12 months. ETHICS AND DISSEMINATION The study has been approved by the Regional Ethics Committee (CPP Ouest) and national authorities (ANSM). The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04341350.
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Affiliation(s)
- Pierre Bailly
- Médecine Intensive et Réanimation, CHRU de Brest, Brest, Bretagne, France
| | - Pierre-Yves Egreteau
- Réanimation polyvalente, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - Stephan Ehrmann
- Médecine Intensive et Réanimation, Centre Hospitalier Régional Universitaire de Tours, Tours, Centre, France
| | - Arnaud W Thille
- Médecine Intensive et Réanimation, CHU de Poitiers, Poitiers, France
- INSERM CIC 1402 Alive Research Group, Université de Poitiers, Poitiers, Poitou-Charentes, France
| | - Christophe Guitton
- Service de Réanimation Médico- Chirurgicale & USC, Centre Hospitalier de Mans, Le Mans, France
| | - Guillaume Grillet
- Réanimation polyvalente, Centre Hospitalier de Lorient, Lorient, Bretagne, France
| | - Florian Reizine
- Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Rennes, Rennes, Bretagne, France
| | - Olivier Huet
- Réanimation chirurgicale, Centre Hospitalier Régional et Universitaire de Brest, Brest, Bretagne, France
| | - S Jaber
- Anesthesia and Critical Care, Montpellier Univ Hosp, Montpellier, France
| | | | - Erwan L'her
- Médecine Intensive et Réanimation, CHRU de Brest, Brest, NA, France
- LATIM INSERM UMR 1101, Université de Bretagne Occidentale, Brest, NA, France
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