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Open Access 01-10-2021 | Opioids | Original Article

Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review

Authors: Azzeddine Kermad, Jacques Speltz, Guy Danziger, Thilo Mertke, Robert Bals, Thomas Volk, Philipp M. Lepper, Andreas Meiser

Published in: Journal of Anesthesia | Issue 5/2021

Abstract

Purpose

In this retrospective study, we compared inhaled sedation with isoflurane to intravenous propofol in invasively ventilated COVID-19 patients with ARDS (Acute Respiratory Distress Syndrome).

Methods

Charts of all 20 patients with COVID-19 ARDS admitted to the ICU of a German University Hospital during the first wave of the pandemic between 22/03/2020 and 21/04/2020 were reviewed. Among screened 333 days, isoflurane was used in 97 days, while in 187 days, propofol was used for 12 h or more. The effect and dose of these two sedatives were compared. Mixed sedation days were excluded.

Results

Patients’ age (median [interquartile range]) was 64 (60–68) years. They were invasively ventilated for 36 [21–50] days. End-tidal isoflurane concentrations were high (0.96 ± 0.41 Vol %); multiple linear regression yielded the ratio (isoflurane infusion rate)/(minute ventilation) as the single best predictor. Infusion rates were decreased under ECMO (3.5 ± 1.4 versus 7.1 ± 3.2 ml∙h⁻¹; p < 0.001). In five patients, the maximum recommended dose of propofol of 4 mg∙hour⁻¹∙kg⁻¹ABW was exceeded on several days. On isoflurane compared to propofol days, neuro-muscular blocking agents (NMBAs) were used less frequently (11% versus 21%; p < 0.05), as were co-sedatives (7% versus 31%, p < 0.001); daily opioid doses were lower (720 [720–960] versus 1080 [720–1620] mg morphine equivalents, p < 0.001); and RASS scores indicated deeper levels of sedation (− 4.0 [− 4.0 to − 3.0] versus − 3.0 [− 3.6 to − 2.5]; p < 0.01).

Conclusion

Isoflurane provided sufficient sedation with less NMBAs, less polypharmacy and lower opioid doses compared to propofol. High doses of both drugs were needed in severely ill COVID-19 patients.

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Title: Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review
Authors: Azzeddine Kermad
Jacques Speltz
Guy Danziger
Thilo Mertke
Robert Bals
Thomas Volk
Philipp M. Lepper
Andreas Meiser
Publication date: 01-10-2021
Publisher: Springer Singapore
Keywords: Opioids
Opioids
Acute Respiratory Distress-Syndrome
COVID-19
ECMO
ECMO
Isoflurane
Propofol
Published in: Journal of Anesthesia / Issue 5/2021
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI: https://doi.org/10.1007/s00540-021-02960-6

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Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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