Ventilatory Effects of Isoflurane Sedation via the Sedaconda ACD-S versus ACD-L: A Substudy of a Randomized Trial

Müller-Wirtz, Lukas M; Becher, Tobias; Günther, Ulf; Bellgardt, Martin; Sackey, Peter; Volk, Thomas; Meiser, Andreas

doi:10.3390/jcm12093314

Cited by 2 publications

(1 citation statement)

References 30 publications

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“…Under our experimental conditions simulating lung-protective ventilation in ARDS, we found that an inhaled sedation device with the lowest dead space still led to a significant and meaningful increase in both EtCO 2 and MP. This result has not been confirmed by a recent clinical study in non-ARDS ICU patients receiving standard ventilation ( V T 8–10 mL/kg), which compared ANA-50 and ANA-100 with conventional intravenous sedation [ 26 ]. Indeed, the authors only found an increase in PaCO 2 or in minute ventilation with ANA-100.…”

Section: Discussionmentioning

confidence: 85%

Effects on mechanical power of different devices used for inhaled sedation in a bench model of protective ventilation in ICU

Pellet,

Stevic,

Degivry

et al. 2024

Ann. Intensive Care

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Background Inhaled sedation during invasive mechanical ventilation in patients with acute respiratory distress syndrome (ARDS) has received increasing attention. However, inhaled sedation devices increase dead-space ventilation and an undesirable effect is the increase in minute ventilation needed to maintain CO2 removal. A consequence of raising minute ventilation is an increase in mechanical power (MP) that can promote lung injury. However, the effect of inhaled sedation devices on MP remains unknown. Methods We conducted a bench study to assess and compare the effects of three devices delivering inhaled sevoflurane currently available in ICU (AnaConDa-50 mL (ANA-50), AnaConDa-100 mL (ANA-100), and MIRUS) on MP by using a test lung model set with three compliances (20, 40, and 60 mL/cmH2O). We simulated lung-protective ventilation using a low tidal volume and two levels of positive end-expiratory pressure (5 and 15 cmH2O) under ambient temperature and dry conditions. Following the insertion of the devices, either the respiratory rate or tidal volume was increased in 15%-steps until end-tidal CO2 (EtCO2) returned to the baseline value. MP was calculated at baseline and after EtCO2 correction using a simplified equation. Results Following device insertion, the EtCO2 increase was significantly greater with MIRUS (+ 78 ± 13%) and ANA-100 (+ 100 ± 11%) than with ANA-50 (+ 49 ± 7%). After normalizing EtCO2 by adjusting minute ventilation, MP significantly increased by more than 50% with all inhaled sedation devices compared to controls. The lowest increase in MP was observed with ANA-50 (p < 0.05 versus ANA-100 and MIRUS). The Costa index, another parameter assessing the mechanical energy delivered to the lungs, calculated as driving pressure × 4 + respiratory rate, significantly increased by more than 20% in all experimental conditions. Additional experiments performed under body temperature, ambient pressure, and gas saturated with water vapor conditions, confirmed the main results with an increase in MP > 50% with all devices after normalizing EtCO2 by adjusting minute ventilation. Conclusion Inhaled sedation devices substantially increased MP in this bench model of protective ventilation, which might limit their benefits in ARDS.

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Section: Discussionmentioning

confidence: 85%

Effects on mechanical power of different devices used for inhaled sedation in a bench model of protective ventilation in ICU

Pellet,

Stevic,

Degivry

et al. 2024

Ann. Intensive Care

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Volatile anesthetics for lung- and diaphragm-protective sedation

Müller-Wirtz,

O’Gara,

Gama de Abreu

et al. 2024

Crit Care

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This review explores the complex interactions between sedation and invasive ventilation and examines the potential of volatile anesthetics for lung- and diaphragm-protective sedation. In the early stages of invasive ventilation, many critically ill patients experience insufficient respiratory drive and effort, leading to compromised diaphragm function. Compared with common intravenous agents, inhaled sedation with volatile anesthetics better preserves respiratory drive, potentially helping to maintain diaphragm function during prolonged periods of invasive ventilation. In turn, higher concentrations of volatile anesthetics reduce the size of spontaneously generated tidal volumes, potentially reducing lung stress and strain and with that the risk of self-inflicted lung injury. Taken together, inhaled sedation may allow titration of respiratory drive to maintain inspiratory efforts within lung- and diaphragm-protective ranges. Particularly in patients who are expected to require prolonged invasive ventilation, in whom the restoration of adequate but safe inspiratory effort is crucial for successful weaning, inhaled sedation represents an attractive option for lung- and diaphragm-protective sedation. A technical limitation is ventilatory dead space introduced by volatile anesthetic reflectors, although this impact is minimal and comparable to ventilation with heat and moisture exchangers. Further studies are imperative for a comprehensive understanding of the specific effects of inhaled sedation on respiratory drive and effort and, ultimately, how this translates into patient-centered outcomes in critically ill patients. Graphical abstract

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Ventilatory Effects of Isoflurane Sedation via the Sedaconda ACD-S versus ACD-L: A Substudy of a Randomized Trial

Cited by 2 publications

References 30 publications

Effects on mechanical power of different devices used for inhaled sedation in a bench model of protective ventilation in ICU

Effects on mechanical power of different devices used for inhaled sedation in a bench model of protective ventilation in ICU

Volatile anesthetics for lung- and diaphragm-protective sedation

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