title: Volatile Agents in Medical and Surgical Intensive Care Units: A Meta-Analysis of Randomized Clinical Trials.
abstract: OBJECTIVE
  To comprehensively assess published randomized peer-reviewed studies related to volatile agents used for sedation in intensive care unit (ICU) settings, with the hypothesis that volatile agents could reduce time to extubation in adult patients.
  
  
  METHODS
  Systematic review and meta-analysis of randomized trials.
  
  
  METHODS
  Intensive care units.
  
  
  METHODS
  Critically ill patients.
  
  
  METHODS
  None.
  
  
  RESULTS
  The BioMedCentral, PubMed, Embase, and Cochrane Central Register databases of clinical trials were searched systematically for studies on volatile agents used in the ICU setting. Articles were assessed by trained investigators, and divergences were resolved by consensus. Inclusion criteria included random allocation to treatment (volatile agents versus any intravenous comparator, with no restriction on dose or time of administration) in patients requiring mechanical ventilation in the ICU. Twelve studies with 934 patients were included in the meta-analysis. The use of halogenated agents reduced the time to extubation (standardized mean difference = -0.78 [-1.01 to -0.55] hours; p for effect<0.00001; p for heterogeneity = 0.18; I(2) = 32% in 7 studies with 503 patients). Results for time to extubation were confirmed in all subanalyses (eg, medical and surgical patients) and sensitivity analyses. No differences in length of hospital stay, ICU stay, and mortality were recorded.
  
  
  CONCLUSIONS
  In this meta-analysis of randomized trials, volatile anesthetics reduced time to extubation in medical and surgical ICU patients. The results of this study should be confirmed by large and high-quality randomized controlled studies.
authors.affiliation: IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: landoni.giovanni@hsr.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.affiliation: IRCCS San Raffaele Scientific Institute.
authors.forename: Laura
authors.initials: L
authors.lastname: Pasin
authors.affiliation: IRCCS San Raffaele Scientific Institute.
authors.forename: Luca
authors.initials: L
authors.lastname: Cabrini
authors.affiliation: IRCCS San Raffaele Scientific Institute.
authors.forename: Anna Mara
authors.initials: AM
authors.lastname: Scandroglio
authors.affiliation: IRCCS San Raffaele Scientific Institute.
authors.forename: Martina
authors.initials: M
authors.lastname: Baiardo Redaelli
authors.affiliation: IRCCS San Raffaele Scientific Institute.
authors.forename: Carmine Domenico
authors.initials: CD
authors.lastname: Votta
authors.affiliation: IRCCS San Raffaele Scientific Institute.
authors.forename: Mattia
authors.initials: M
authors.lastname: Bellandi
authors.affiliation: IRCCS San Raffaele Scientific Institute.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Borghi
authors.affiliation: IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D060666:Airway Extubation / Q000706:statistics & numerical data*; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D003422:Critical Care / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D016032:Randomized Controlled Trials as Topic
chemical_list: D018685:Anesthetics, Inhalation
keywords: anesthesia; critically ill; intensive care; mechanical ventilation; sedation; volatile agents