Inhaled Sedation in Patients with COVID-19-Related Acute Respiratory Distress Syndrome: An International Retrospective Study

Randy Coupet¹, Martin Schläpfer^{2

3}, Thomas A Neff⁴, Pierre Boucher⁵, Pierre Bailly⁶, Martin Bellgardt⁷, Rafael Badenes⁸, Jose Carbonell⁸, Tobias Becher⁹, Caroline Varillon¹⁰, Dominique Morand¹, Raiko Blondonnet^{1

11}, Jean-Michel Constantin¹², Bruno Pereira¹³, Brian O'Gara¹⁴, Matthieu Jabaudon^{1

11}; ISCA Study Group

Affiliations

¹ Department of Anesthesiology, Critical Care and Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
² Institute of Anesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland.
³ Institute of Physiology, University Zurich, 8057 Zurich, Switzerland.
⁴ Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital Muensterlingen, 8596 Muensterlingen, Switzerland.
⁵ Department of Anesthesiology and Critical Care, Ramsay Santé Private Hospital de la Loire, 42100 Saint-Etienne, France.
⁶ Department of Medical Intensive Care, CHRU Brest, 29609 Brest, France.
⁷ St. Josef-Hospital, University Hospital of Ruhr-University of Bochum, 44791 Bochum, Germany.
⁸ Department of Anesthesiology and Intensive Care, Hospital Clìnico Universitario de Valencia, University of Valencia, 46010 Valencia, Spain.
⁹ Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany.
¹⁰ Department of Medical Intensive Care, Dunkerque Hospital, 59240 Dunkerque, France.
¹¹ iGReD-Genetics Reproduction and Development Research Unit, National Center for Scientific Research (CNRS), National Institute of Health and Medical Research (INSERM), Clermont Auvergne University, 63001 Clermont-Ferrand, France.
¹² Department of Anesthesiology and Critical Care, GRC 29, DMU DREAM, Pitié-Salpêtrière Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France.
¹³ Biostatistics and Data Management Unit, Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
¹⁴ Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA.

PMID: 36614813
PMCID: PMC9821008
DOI: 10.3390/jcm12010012

Inhaled Sedation in Patients with COVID-19-Related Acute Respiratory Distress Syndrome: An International Retrospective Study

Randy Coupet et al. J Clin Med. 2022.

. 2022 Dec 20;12(1):12.

doi: 10.3390/jcm12010012.

Authors

Affiliations

¹ Department of Anesthesiology, Critical Care and Perioperative Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
² Institute of Anesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland.
³ Institute of Physiology, University Zurich, 8057 Zurich, Switzerland.
⁴ Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital Muensterlingen, 8596 Muensterlingen, Switzerland.
⁵ Department of Anesthesiology and Critical Care, Ramsay Santé Private Hospital de la Loire, 42100 Saint-Etienne, France.
⁶ Department of Medical Intensive Care, CHRU Brest, 29609 Brest, France.
⁷ St. Josef-Hospital, University Hospital of Ruhr-University of Bochum, 44791 Bochum, Germany.
⁸ Department of Anesthesiology and Intensive Care, Hospital Clìnico Universitario de Valencia, University of Valencia, 46010 Valencia, Spain.
⁹ Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany.
¹⁰ Department of Medical Intensive Care, Dunkerque Hospital, 59240 Dunkerque, France.
¹¹ iGReD-Genetics Reproduction and Development Research Unit, National Center for Scientific Research (CNRS), National Institute of Health and Medical Research (INSERM), Clermont Auvergne University, 63001 Clermont-Ferrand, France.
¹² Department of Anesthesiology and Critical Care, GRC 29, DMU DREAM, Pitié-Salpêtrière Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France.
¹³ Biostatistics and Data Management Unit, Department of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
¹⁴ Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA.

PMID: 36614813
PMCID: PMC9821008
DOI: 10.3390/jcm12010012

Abstract

Background and objectives: The coronavirus disease 2019 (COVID-19) pandemic and the shortage of intravenous sedatives has led to renewed interest in inhaled sedation for patients with acute respiratory distress syndrome (ARDS). We hypothesized that inhaled sedation would be associated with improved clinical outcomes in COVID-19 ARDS patients.

Methods: Retrospective international study including mechanically ventilated patients with COVID-19 ARDS who required sedation and were admitted to 10 European and US intensive care units. The primary endpoint of ventilator-free days through day 28 was analyzed using zero-inflated negative binomial regression, before and after adjustment for site, clinically relevant covariates determined according to the univariate results, and propensity score matching.

Results: A total of 196 patients were enrolled, 78 of whom died within 28 days. The number of ventilator-free days through day 28 did not differ significantly between the patients who received inhaled sedation for at least 24 h (n = 111) and those who received intravenous sedation only (n = 85), with medians of 0 (interquartile range [IQR] 0-8) and 0 (IQR 0-17), respectively (odds ratio for having zero ventilator-free days through day 28, 1.63, 95% confidence interval [CI], 0.91-2.92, p = 0.10). The incidence rate ratio for the number of ventilator-free days through day 28 if not 0 was 1.13 (95% CI, 0.84-1.52, p = 0.40). Similar results were found after multivariable adjustment and propensity matching.

Conclusion: The use of inhaled sedation in COVID-19 ARDS was not associated with the number of ventilator-free days through day 28.

Keywords: acute respiratory distress syndrome; coronavirus disease 2019; inhaled sedation; isoflurane; sevoflurane.

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Conflict of interest statement

M.S. has received unrestricted research grants from Roche Diagnostics International, Rotkreuz, Switzerland and from Sedana Medical, Danderyd Sweden. M.S. has submitted a patent to mitigate the negative effects of surgery and/ or anesthesia for patients using medical gases, particularly oxygen and carbon dioxide. M.J. is a principal investigator of the SESAR trial (ClinicalTrials.gov Identifier: NCT04235608), a trial funded by the French Ministry of Health, the European Society of Anaesthesiology, and Sedana Medical. J.-M.C. and M.J. received fees from Sedana Medical for participation in scientific advisory panels; M.J. received fees from Sedana Medical for participation in scientific seminars; M.J. received consulting fees and fees for participation in a scientific advisory panel from Abbvie. There was no influence from these entities in the study design, collection, analysis, interpretation of data, and in writing. Other authors have no disclosure.

Figures

**Figure 2**
Primary outcome of ventilator-free days through day 28. (A) Median values (with interquartile ranges) in the patients who received inhaled sedation for at least 24 h (inhaled sedation group) and those who received intravenous sedation only (intravenous sedation group) through day 28. (B) Distribution of ventilator-free days through day 28 in both study groups.

See this image and copyright information in PMC

References

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Inhaled Sedation in Patients with COVID-19-Related Acute Respiratory Distress Syndrome: An International Retrospective Study

Affiliations

Inhaled Sedation in Patients with COVID-19-Related Acute Respiratory Distress Syndrome: An International Retrospective Study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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