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. 2025 Aug 1;53(8):e1659-e1665.
doi: 10.1097/CCM.0000000000006744. Epub 2025 Jun 16.

Effects of Sevoflurane Inhalation on Pulmonary Hemodynamics in Moderate to Severe Acute Respiratory Distress Syndrome Patients With Septic Shock: A Prospective Cohort Study

Giovanni Bousquet  1   2 , Gabriel Parzy  1 , Damien Barrau  1   2 , Ines Gragueb-Chatti  1   2 , Florence Daviet  1   2 , Mélanie Adda  1   2 , Saida Salmi  1   2 , Geoffray Agard  1   2 , Jean-Marie Forel  1   2 , Antoine Roch  1   2 , Laurent Papazian  3   4 , Sami Hraiech  1   2 , Christophe Guervilly  1   2
Affiliations

Effects of Sevoflurane Inhalation on Pulmonary Hemodynamics in Moderate to Severe Acute Respiratory Distress Syndrome Patients With Septic Shock: A Prospective Cohort Study

Giovanni Bousquet et al. Crit Care Med. .

Abstract

Objectives: Our study aimed to investigate the effects of sevoflurane inhalation on mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistances (PVRs) in acute respiratory distress syndrome (ARDS) patients during lung protective ventilation.

Design: Prospective cohort study.

Setting: Medical ICU of a university teaching hospital.

Patients: Deeply sedated, intubated adult patients with moderate to severe ARDS with Pa o2 /F io2 less than 150 mm Hg, with a positive end-expiratory pressure of greater than or equal to 5 cm H 2 O and septic shock monitored with a pulmonary arterial catheter.

Interventions: Sedation was switched from IV midazolam to sevoflurane inhalation.

Measurements and main results: Main objective was the change in mPAP between before (T0) and 1 hour (H + 1) after sevoflurane inhalation. Main secondary outcomes were mPAP 12-18 hours (H + 12-18) after inclusion, PVR indexed (PVRI), cardiac index, Pa o2 /F io2 , pulmonary shunt at H + 1, and H + 12-18 after inclusion. The H + 12-18 measurements were performed either in supine position (SP) or in prone position (PP), if Pa o2 /F io2 ratio was less than 150 mm Hg at H + 1. Fifteen patients were included in interim analysis. mPAP was 24 ± 4 mm Hg at inclusion and remained unchanged after 1 hour (24 ± 5 mm Hg) and 12-18 hours (23 ± 6 mm Hg) of sevoflurane inhalation. The mean expired fraction of sevoflurane was 0.75% ± 0.25% at H + 1 and 0.71% ± 0.25% at H + 12-18. No significant variations in PVRI, cardiac index, mean arterial pressure, pulmonary shunt were observed at H + 1 and H + 12-18. An improvement of Pa o2 /F io2 was observed at H + 12-18 in patients who remained in SP (from 158 ± 49 to 249 ± 86 mm Hg; p = 0.015) and in those turned prone (from 134 ± 36 to 241 ± 109 mm Hg; p = 0.018).

Conclusions: In mechanically ventilated moderate to severe ARDS patients receiving lung protective ventilation, sevoflurane inhalation was not associated with decreases in mPAPs and PVRs. However, the smaller than planned sample size does not allow definitive conclusions.

Keywords: acute respiratory distress syndrome; inhaled sedation; pulmonary hypertension; sevoflurane.

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Conflict of interest statement

Drs. Papazian’s and Guervilly’s institutions received funding from Sedana Medical. Dr. Papazian’s institution received funding from Linet and Hamilton; he received funding from Air Liquide Medical Systems, Faron, and Merck Sharp & Dohme. Dr. Guervilly received support for article research from Sedana Medical; he reported personal consulting fees from Xenios Fresenus Medical Care. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. Müller-Wirtz LM, O’Gara B, Gama de Abreu M, et al.: Volatile anesthetics for lung- and diaphragm-protective sedation. Crit Care 2024; 28:269
    1. Boissier F, Katsahian S, Razazi K, et al.: Prevalence and prognosis of cor pulmonale during protective ventilation for acute respiratory distress syndrome. Intensive Care Med 2013; 39:1725–1733
    1. Du G, Wang S, Li Z, et al.: Sevoflurane posttreatment attenuates lung injury induced by oleic acid in dogs. Anesth Analg 2017; 124:1555–1563
    1. Ranieri VM, Rubenfeld GD, Thompson BT, et al.; ARDS Definition Task Force: Acute respiratory distress syndrome: The Berlin definition. JAMA 2012; 307:2526–2533
    1. Guérin C, Reignier J, Richard JC, et al.; PROSEVA Study Group: Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013; 368:2159–2168

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