Sevoflurane improves respiratory mechanics and gas exchange in a case series of infants with severe bronchiolitis‐induced acute respiratory distress syndrome

Nacoti, Mirco; Colombo, Jacopo; Fochi, Oliviero; Bonacina, Daniele; Fazzi, Francesco; Bellani, Giacomo; Bonanomi, Ezio

doi:10.1002/ccr3.1490

Cited by 7 publications

(5 citation statements)

References 27 publications

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“…Hence, we cannot exclude that the early decrease in blood pressure was the result of a potential oversedation caused by the combination of isoflurane and the intravenous sedatives which had not yet been reduced sufficiently or had long half-lifes. Vasopressors had to be started or increased in 93% of the children, a fact that is in line with Nacoti et al 22 Moreover, we observed 2 clinically relevant episodes of hypotension that were clearly related to isoflurane and required immediate therapy and discontinuation of LTIS in 1 patient. Heart rate also decreased regularly, but to a lesser extent.…”

Section: Discussionsupporting

confidence: 89%

“…Bronchospasm requiring specific medication was observed in 2 of 23 children by Mencia et al, 15 and 2 patients had seizures related to the inhalative sedation. 17,22 Neither bronchospasm nor seizures were observed in our study cohort. Based on the timedependent increase of fluoride in the blood reported by Arnold et al, 20 we also analyzed plasma fluoride levels in some of our patients.…”

Section: Discussionmentioning

confidence: 61%

“…Isoflurane and sevoflurane are potent vasodilators, and 11 of 41 (27%) patients from the literature developed at least mild arterial hypotension. 15,17,20,22 However, Eifinger et al did not report hypotension in their 15 patients. 21 We recorded hemodynamic parameters very thoroughly in our patients, and found that mean arterial blood pressure decreased in all patients within 24 hours after the start of isoflurane sedation.…”

Section: Discussionmentioning

confidence: 82%

“…17 None of the 15 patients in the study by Eifinger et al had primary pulmonary pathology, and only a small subset of patients (4/23) in the study by Mencia et al were ventilated due to respiratory disease. 15,21 Another 5 infants with severe bronchiolitis due to infection with respiratory syncitial virus (RSV) received LTIS with sevoflurane in the case report series by Nacoti et al 22 Although the period of inhalative sedation was rather short (mean Sevoflurane MAC-hours: 41.2), increased respiratory mechanics and gas exchange could be demonstrated in all 5 patients. Despite of the low patient number, this study is remarkable because bronchial obstruction plays a major role in the pathogenesis of RSV bronchiolitis, and sevoflurane as well as isoflurane are potent bronchodilators.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Inhalative Sedation in Children With Pulmonary Diseases

Meyburg

Frommhold

Motsch

et al. 2020

J Intensive Care Med

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Objectives: To describe safety and feasibility of long-term inhalative sedation (LTIS) in children with severe respiratory diseases compared to patients with normal lung function with respect to recent studies that showed beneficial effects in adult patients with acute respiratory distress syndrome (ARDS). Design: Single-center retrospective study. Setting: 12-bed pediatric intensive care unit (PICU) in a tertiary-care academic medical center in Germany. Patients: All patients treated in our PICU with LTIS using the AnaConDa® device between July 2011 and July 2019. Measurements and Main Results: Thirty-seven courses of LTIS in 29 patients were analyzed. LTIS was feasible in both groups, but concomitant intravenous sedatives could be reduced more rapidly in children with lung diseases. Cardiocirculatory depression requiring vasopressors was observed in all patients. However, severe side effects only rarely occured. Conclusions: In this largest cohort of children treated with LTIS reported so far, LTIS was feasible even in children with severely impaired lung function. From our data, a prospective trial on the use of LTIS in children with ARDS seems justified. However, a thorough monitoring of cardiocirculatory side effects is mandatory.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Long-Term Inhalative Sedation in Children With Pulmonary Diseases

Meyburg

Frommhold

Motsch

et al. 2020

J Intensive Care Med

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“…(Hornuss et al 2010) Sevoflurane improved pulmonary mechanics and gas exchange in a case series of infants with severe bronchiolitis and acute respiratory distress syndrome. (Nacoti et al 2018) In short, a controlled clinical trial of isoflurane or sevoflurane when intubated COVID-19 patients are sedated is warranted.…”

mentioning

confidence: 99%

COVID-19 and heme oxygenase: novel insight into the disease and potential therapies

Hooper

2020

Cell Stress and Chaperones

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The COVID-19 pandemic needs therapies that are presently available and safe. We propose that subjects with metabolic syndrome, old age, and male gender have the greatest morbidity and mortality and have low stress proteins, in particular, low intracellular heme oxygenase (HO-1), making them particularly vulnerable to the disease. Additionally, COVID-19's heme reduction may contribute to even lower HO-1. Low-grade inflammation associated with these risk factors contributes to triggering a cytokine storm that spreads to multi-organ failure and near death. The high mortality of those treated with ventilator assistance may partially be explained by ventilator-induced inflammation. The cytoprotective and anti-inflammatory properties of HO-1 can limit the infection's damage. A paradox of COVID-19 hospital admissions data suggests that fewer cigarettesmokers are admitted compared with non-smokers in the general population. This unexpected observation may result from smoke induction of HO-1. Therapies with anti-viral properties that raise HO-1 include certain anesthetics (sevoflurane or isoflurane), hemin, estrogen, statins, curcumin, resveratrol, and melatonin. Controlled trials of these HO-1 inducers should be done in order to prevent or treat COVID-19 disease.

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Halogenated volatile anaesthetics for prolonged sedation in pediatric intensive care unit: first experience in two French pediatric intensive care units

Berger

Sorèze

Rambaud

et al. 2023

Intensive Care Med. Paediatr. Neonatal

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Objective Sedation is necessary for patients to achieve comfort and safety, but prolonged sedation can lead to the need for increased doses, resulting in withdrawal syndrome and delayed extubation. Inhaled anaesthetics (IAs) may cause less withdrawal syndrome while providing similar sedative effects to intravenous agents. This study aims to describe the efficacy of halogenated IAs during prolonged sedation and identify any adverse effects on the PICU. Design This is a retrospective, bicentric cohort study. Setting The study was conducted at two PICUs in university hospitals in Paris between January 2018 and December 2020. Patients The study included 50 children (aged 2.2 years, [0.8–7.2]) who received prolonged sedation (> 72 h) and were sedated with volatile anaesthetics for at least 24 h. Interventions No interventions were performed. Measurements and main results The study found a statistically significant reduction in benzodiazepine dosages (μg/kg/h) (118 [62.5; 200] vs 80.0 [32.5; 120], p < 0.01). Similar results were observed for other hypnotics (ketamine 2.00 [1.00; 2.00] vs 1.50 [1.00; 2.00], p = 0.036, mg/kg/h; clonidine: 0.55 [0.35; 1.27] vs 0.20 [0.12; 0.43], p = 0.036, μg/kg/h). For opioids (μg/kg/h), no significant reduction in doses was observed 24 h after IA introduction (4 [1.00; 8.00] vs 4.00 [1.00; 6.70], p = 0.7). No major adverse effects were reported, although 26% of patients developed withdrawal syndrome. Conclusions Halogenated IAs appear to be a promising therapy to reduce the dosages of hypnotics and opioids used during prolonged sedations.

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Sevoflurane improves respiratory mechanics and gas exchange in a case series of infants with severe bronchiolitis‐induced acute respiratory distress syndrome

Cited by 7 publications

References 27 publications

Long-Term Inhalative Sedation in Children With Pulmonary Diseases

Long-Term Inhalative Sedation in Children With Pulmonary Diseases

COVID-19 and heme oxygenase: novel insight into the disease and potential therapies

Halogenated volatile anaesthetics for prolonged sedation in pediatric intensive care unit: first experience in two French pediatric intensive care units

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