title: Isoflurane Sedation on the ICU in Cardiac Arrest Patients Treated With Targeted Temperature Management: An Observational Propensity-Matched Study.
abstract: OBJECTIVE
  Targeted temperature management after cardiac arrest requires deep sedation to prevent shivering and discomfort. Compared to IV sedation, volatile sedation has a shorter half-life and thus may allow more rapid extubation and neurologic assessment.
  
  
  METHODS
  Observational analysis of clinical data.
  
  
  METHODS
  University hospital, medical ICU.
  
  
  METHODS
  Four hundred thirty-two cardiac arrest survivors underwent targeted temperature management; of those, 110 were treated with volatile sedation using an anesthetic conserving device and isoflurane, and 322 received standard IV sedation.
  
  
  METHODS
  No intervention.
  
  
  RESULTS
  A matched pairs analysis revealed that time on ventilator (difference of median, 98.5 hr; p = 0.003) and length of ICU stay (difference of median, 4.5 d; p = 0.006) were significantly shorter in patients sedated with isoflurane when compared with IV sedation although no differences in neurologic outcome (45% of patients with cerebral performance category 1-2 in both groups) were observed. Significant hypercapnia occurred more frequently during anesthetic conserving device use (6.4% vs 0%; p = 0.021).
  
  
  CONCLUSIONS
  Volatile sedation is feasible in cardiac arrest survivors. Prospective controlled studies are necessary to confirm the beneficial effects on duration of ventilation and length of ICU stay observed in our study. Our data argue against a major effect on neurologic outcome. Close monitoring of PaCO2 is necessary during sedation via anesthetic conserving device.
authors.affiliation: 1Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany.2Department of Neurology, Chariteé-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Krannich
authors.forename: Christoph
authors.initials: C
authors.lastname: Leithner
authors.forename: Martin
authors.initials: M
authors.lastname: Engels
authors.forename: Jens
authors.initials: J
authors.lastname: Nee
authors.forename: Victor
authors.initials: V
authors.lastname: Petzinka
authors.forename: Tim
authors.initials: T
authors.lastname: Schröder
authors.forename: Achim
authors.initials: A
authors.lastname: Jörres
authors.forename: Jan
authors.initials: J
authors.lastname: Kruse
authors.forename: Christian
authors.initials: C
authors.lastname: Storm
mesh_terms: D000280:Administration, Inhalation; D061605:Administration, Intravenous; D000368:Aged; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001831:Body Temperature; D054810:Deep Sedation / Q000379:methods; D004569:Electroencephalography / Q000187:drug effects; D005073:Evoked Potentials, Somatosensory / Q000187:drug effects; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006323:Heart Arrest / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D006935:Hypercapnia / Q000139:chemically induced; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007362:Intensive Care Units; D007530:Isoflurane / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D010751:Phosphopyruvate Hydratase / Q000097:blood; D057216:Propensity Score; D012121:Respiration, Artificial; D012189:Retrospective Studies
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D007530:Isoflurane; D010751:Phosphopyruvate Hydratase; D008874:Midazolam; D005283:Fentanyl