Clinical Studies (Lung)

Estudios Clínicos Pulmón

Inhaled Sedation in Patients With Acute Respiratory Distress Syndrome Undergoing Extracorporeal Membrane Oxygenation.

Meiser et al
Anesth Analg 2017

Six patients suffering from acute respiratory distress syndrome with the need for extracorporeal membrane oxygenation (ECMO) therapy in deep sedation were included.

Isoflurane sedation with the AnaConDa system was initiated within 24 hours after initiation of ECMO therapy and resulted in a satisfactory sedation (Richmond Agitation-Sedation Scale -4 to -5). Despite deep sedation, spontaneous breathing was possible in 6 of 6 patients. We observed a reduced need for vasopressor therapy and improved lung function (PaO2, PaCO2, delta P, and tidal volume) during isoflurane sedation. Opioid consumption could be reduced, and only very low doses of isoflurane were needed (1 mL/h to 3 mL/h).

This small case series supports the feasibility of sedation using inhaled anesthetics concurrently with venovenous ECMO.

Sevoflurane for Sedation in Acute Respiratory Distress Syndrome. A Randomized Controlled Pilot Study

Jabaoudon et al
American Journal of Respiratory and Critical Care Medicine 2016

To assess whether sevoflurane would improve gas exchange and inflammation in ARDS.

Twenty-five patients were assigned to the sevoflurane group and 25 to the midazolam group. On Day 2, PaO2/FiO2 ratio was higher in the sevoflurane group than in the midazolam group (mean ± SD, 205 ± 56 vs. 166 ± 59, respectively; P = 0.04). There was a significant reduction over time in cytokines and soluble form of the receptor for advanced glycation end-products levels in the sevoflurane group, compared with the midazolam group, and no serious adverse event was observed with sevoflurane.

In patients with ARDS, use of inhaled sevoflurane improved oxygenation and decreased levels of a marker of epithelial injury and of some inflammatory markers, compared with midazolam.

Sevoflurane, but not propofol, reduces the lung inflammatory response and improves oxygenation in an acute respiratory distress syndrome model.

Ferrando et al
Eur J Anaesthesiol 2013

The goal of this study was to confirm whether or not sevoflurane is more effective than propofol in ameliorating the inflammatory response in an animal model of acute respiratory distress syndrome.

At 240 min, median and interquartile range (IQR) concentrations of cytokines in bronchial lavage specimens in group S were lower than those in group P [interleukin-1b (IL-1b) 53, IQR 16–140 vs. 311, IQR 183–637 pg ml 1, P¼0.04; tumour necrosis factor-a 347, IQR 161–433 vs. 552, IQR 475–649 pg ml 1, P¼0.04; and IL-6 101, IQR 76–282 vs. 580, IQR 369–701 pg ml 1, P¼0.03]. The polymorphonuclear neutrophil count was also lower in group S (P¼0.007), which also had a higher PaO2/FiO2 ratio.

“In an animal model of acute respiratory distress syndrome, sevoflurane ameliorates the lung inflammatory response and improves oxygenation to a greater extent than propofol.”

Severe exacerbation of a respiratory COPD VV-ECMO combined with inhalation anaesthesia

Laufenberg et al
Medizinische Klinik – Intensivmedizin und Notfallmedizin 2016

58-year male patientwas admitted to the intensive care unit of our hospital due to an
exacerbated COPD (GOLD IV) complicated by a pneumonia. The clinical course deteriorated
despite of evidence based intensive care treatment and lung protective ventilation,
a vv-ECMO and a volatile sedation were established. After a few days vv-ECMO
could be discontinued and the patient was discharged from hospital after 20 days.
Our case report suggests that early support with vv-ECMO could reduce the cumulative
duration of invasive ventilation in case of severe COPD exacerbation. The combination
with volatile sedatives make it possible to guide the patient to spontaneous breathing
with only a short weaning period.