ICU

1. Prolonged sedation with sevoflurane in
comparison to intravenous sedation in
critically ill patients
A randomized csntrolled trial
Wasihun, Eden and Eshetu

2. Background
 Title :Prolonged sedation with sevoflurane in
comparison to intravenous sedation in critically ill
patients
 Type of study :randomized control trial
Study by: Bailly P, Egreteau P-Y, Ehrmann S, et al.
Published year: 2020
Published by: BMJ Open

3. Introduction
 Sedation and analgesia are fundamentals for managing
critically ill patients.
Evidence is increasing that volatile anaesthetic agents could be
associated with better outcome.
Sedatives are administered to critically ill patients to relieve anxiety,
reduce the stress of mechanical ventilation and prevent agitation-
related harm
Sedative drugs and their active metabolites can accumulate, leading
to prolonged deep sedation, respiratory depression, immune
suppression and hypotension.

4. Under sedation leads to agitation, hyper catabolism,
self-harm and unplanned extubation
Over sedation may increase the duration of
mechanical ventilation, exposing patient to
ventilator acquired pneumonia
Halogenated gases can be used with ICU ventilators.
Their dose adjustment is simple, no active
metabolites and cleared by breathing.

5. Objectives
General objective
Determine the impact on the delirium occurrence of
an inhaled sedation strategy versus an intravenous
sedation strategy in ICU mechanically ventilated
patients.
Specific objective
To determine the impact of inhalational agent on
the occurrence of delirium.
To determine the impact of inhalational agent on
the occurrence of delirium.

6. Method
 Melticentered ,Prospective ,open level RCT
 Study period starting from July 2020
 Study area 10 ICU in France
 Population Adult ICU patients

7. Control group intravenous sedation with propofol
infusion
Interventional group patient taking inhalational
sedation with Isoflurane

8. Inclusion criteria
 Patients eligible to be enrolled in this trial are
adult ICU patients (>18 years) within 24 hours of
intubation and who are expected to require
mechanical ventilation for at least 24 hours.
 patient requiring immediate ongoing sedative
medication for comfort, safety, and to facilitate
the delivery of life support measures.

9. Exclusion criteria
 Age less than 18 years; the patient who has been
intubated for more than 24 hours in the ICU.
 Admission for a cardiac arrest, a traumatic brain
injury and/or a stroke.
 The patient who is unable to complete the
neuropsychological test due to aphasia, deafness,
blindness or dementia.
contraindication to isoflurane (personal or familial
history of malignant hyperthermia; liver failure with
prothrombin <30%; acute or chronic neuromuscular
disease);

10.  Occurrence of a severe acute respiratory distress
syndrome (ARDS)
 Death is deemed to be imminent or inevitable
during the ICU admission
 Pregnancy or breastfeeding woman;
 Patient under the guardianship or curatorship.

11. Sample size and sampling procedure
They assumed that delirium will be decreased by
50% in inhalational sedation from 30 in iv sedation
Total sample size was 254
Sampling procedure was randomized open level

12. Intervention

13. Analysis
analyses was performed by an independent
statistician
All the analyses will be conducted using SAS V.9.3
statistical software (SAS Institute).
A two-tailed p value equal or less than 0.05 will be
considered as statistically significant.

14. Result