Opportunity Knocks? The Expansion of Volatile Agent Use in New Clinical Settings

Jerath, Angela; Parotto, Matteo; Wąsowicz, Marcin; Ferguson, Niall D.

doi:10.1053/j.jvca.2017.12.035

Cited by 3 publications

(2 citation statements)

References 82 publications

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“…It costs about 150 € or 1 € h −1 . Its long durability is achieved by the fact that the filter is kept separate from the carbon reflector [15]. Furthermore, devices to reduce atmospheric VA pollution must be considered.…”

Section: Discussionmentioning

confidence: 99%

Use of MIRUS™ for MAC-driven application of isoflurane, sevoflurane, and desflurane in postoperative ICU patients: a randomized controlled trial

Bellgardt

Georgevici

Klutzny

et al. 2019

Ann. Intensive Care

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BackgroundThe MIRUS™ (TIM, Koblenz, Germany) is an electronical gas delivery system, which offers an automated MAC (minimal alveolar concentration)-driven application of isoflurane, sevoflurane, or desflurane, and can be used for sedation in the intensive care unit. We investigated its consumption of volatile anesthetics at 0.5 MAC (primary endpoint) and the corresponding costs. Secondary endpoints were the technical feasibility to reach and control the MAC automatically, the depth of sedation at 0.5 MAC, and awakening times. Mechanically ventilated and sedated patients after major surgery were enrolled. Upon arrival in the intensive care unit, patients obtained intravenous propofol sedation for at least 1 h to collect ventilation and blood gas parameters, before they were switched to inhalational sedation using MIRUS™ with isoflurane, sevoflurane, or desflurane. After a minimum of 2 h, inhalational sedation was stopped, and awakening times were recorded. A multivariate electroencephalogram and the Richmond Agitation Sedation Scale (RASS) were used to assess the depth of sedation. Vital signs, ventilation parameters, gas consumption, MAC, and expiratory gas concentrations were continuously recorded.ResultsThirty patients obtained inhalational sedation for 18:08 [14:46–21:34] [median 1st–3rd quartiles] hours. The MAC was 0.58 [0.50–0.64], resulting in a Narcotrend Index of 37.1 [30.9–42.4] and a RASS of − 3.0 [− 4.0 to (− 3.0)]. The median gas consumption was significantly lowest for isoflurane ([ml h−1]: isoflurane: 3.97 [3.61–5.70]; sevoflurane: 8.91 [6.32–13.76]; and desflurane: 25.88 [20.38–30.82]; p < 0.001). This corresponds to average costs of 0.39 € h−1 for isoflurane, 2.14 € h−1 for sevoflurane, and 7.54 € h−1 for desflurane. Awakening times (eye opening [min]: isoflurane: 9:48 [4:15–20:18]; sevoflurane: 3:45 [0:30–6:30]; desflurane: 2:00 [1:00–6:30]; p = 0.043) and time to extubation ([min]: isoflurane: 10:10 [8:00–20:30]; sevoflurane: 7:30 [4:37–14:22]; desflurane: 3:00 [3:00–6:00]; p = 0.007) were significantly shortest for desflurane.ConclusionsA target-controlled, MAC-driven automated application of volatile anesthetics is technically feasible and enables an adequate depth of sedation. Gas consumption was highest for desflurane, which is also the most expensive volatile anesthetic. Although awakening times were shortest, the actual time saving of a few minutes might be negligible for most patients in the intensive care unit. Thus, using desflurane seems not rational from an economic perspective.Trial registration Clinical Trials Registry (ref.: NCT03860129). Registered 24 September 2018—Retrospectively registered.

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Section: Discussionmentioning

confidence: 99%

Use of MIRUS™ for MAC-driven application of isoflurane, sevoflurane, and desflurane in postoperative ICU patients: a randomized controlled trial

Bellgardt

Georgevici

Klutzny

et al. 2019

Ann. Intensive Care

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“…Several ICU trials showed that inhalational based sedation offers several unique advantages over traditional intravenous agents such as benzodiazepines, propofol and opioids [ 15 – 17 ]. Inhalational anaesthetics can be rapidly titrated to standard bedside sedation scores and ventilation mechanics, while also enabling real-time tracking of inspired and expired gas concentrations that correlate with the brain anaesthetic levels [ 19 ]. This additional information provides bedside assessment of actual blood levels that individual patients need to meet their sedation requirements, and enables tracking of sedative elimination during drug weaning, which is a new practice deviation from simple titration of syringe driver pump infusion rates for intravenous sedatives.…”

Section: Repurposing Inhaled Anesthetics As Alternative Icu Sedativesmentioning

confidence: 99%

The impact of the coronavirus pandemic on sedation in critical care: volatile anesthetics in the ICU

Jerath

Slessarev

2022

Current Opinion in Critical Care

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Purpose of review To reflect on the impact of the coronavirus pandemic on sedation for mechanically ventilated patients. Recent findings Shortages of intravenous sedatives during coronavirus pandemic renewed interest in using widely available inhaled anaesthetics for sedation of critically ill patients. Universally used for surgical anaesthesia, inhaled anaesthetics may offer therapeutic advantages in patients with acute lung injury with good sedation profiles, rapid clearance and lower lung inflammation in pilot trials. However, enabling ICU sedation with inhaled anaesthetics required technological and human resource innovation during the chaos of the global pandemic. The disruption of standard sedation practices is challenging during normal operations, yet pandemic facilitated innovation in this field by fostering cross-discipline collaboration supported by healthcare professionals, hospitals, research institutes and regulators. Summary Although further research is needed to establish the role of inhaled anaesthetics in critical care sedation toolkit, maintaining the spirit of innovation ignited during the recent coronavirus pandemic would require ongoing collaboration and streamlining of processes among healthcare, research and regulatory institutions.

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Inhalational Agents: What Volatile Inhalational Agents Are and How to Use Them in the ICU Setting

Rosenberg

Young

Fiedorek

et al. 2020

Sedation and Analgesia for the Pediatric Intensivist

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Opportunity Knocks? The Expansion of Volatile Agent Use in New Clinical Settings

Cited by 3 publications

References 82 publications

Use of MIRUS™ for MAC-driven application of isoflurane, sevoflurane, and desflurane in postoperative ICU patients: a randomized controlled trial

Use of MIRUS™ for MAC-driven application of isoflurane, sevoflurane, and desflurane in postoperative ICU patients: a randomized controlled trial

The impact of the coronavirus pandemic on sedation in critical care: volatile anesthetics in the ICU

Inhalational Agents: What Volatile Inhalational Agents Are and How to Use Them in the ICU Setting

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