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Journal of Artificial Organs

, Volume 21, Issue 2, pp 201–205 | Cite as

Inhalative sedation with small tidal volumes under venovenous ECMO

  • Axel Rand
  • Peter K. Zahn
  • Thomas A. Schildhauer
  • Christian Waydhas
  • Uwe Hamsen
Original Article Artificial Lung / ECMO
  • 168 Downloads

Abstract

Background

Inhalative sedation is an emerging method for long-term sedation in intensive care therapy. There is evidence that it is easy to control and may be beneficial compared to intravenous sedation. Yet little is known about the use in patients with compromised lung function. In this retrospective analysis, we searched files of patients receiving inhalative sedation under venovenous extracorporeal membrane oxygenator (vv-ECMO) support due to lung failure.

Methods

After ethical approval, we performed a retrospective analysis of patients receiving vv-ECMO support and inhalative sedation in the surgical ICU in 2015. Isoflurane was administered via the AnaConDa®-system. Sedation was tested using Richmond Agitation and Sedation scale (RASS).

Results

7 patients were identified. Median age was 50 years (26/70 years). All were male. Median ECMO runtime was 129 h (37/1008 h) and the survival rate was 57.9%. Dose of isoflurane was 1.7 ml/h (0.8 / 4.0 ml/h) resulting in expiratory concentrations of 0.8 Vol% (0.3/1.8 Vol%), inspiratory of 0.6 Vol% (0.1/1.4 Vol%). Higher concentrations of isoflurane were associated with increased depth of sedation (expiratory p = 0.016; inspiratory p = 0.027; averaged p = 0.015). With tidal volume below 350 ml, association was still present for expiratory and averaged concentrations of isoflurane (expiratory p = 0.031; inspiratory p = 0.082; average p = 0.039).

Conclusions

This is the first study that shows that inhalative concentrations of isoflurane are associated with depth of sedation in patients with lung failure. We were able to show that even with major impacts in lung mechanics and function targeted sedation with volatile anaesthetics is feasible and dose–response relationship appears to exist.

Keywords

ECMO Lung failure Inhalative sedation Isoflurane Anaconda ARDS Adult Intensive care Sedation 

Abbreviations

vv-ECMO

Venovenous extracorporeal membrane oxygenator

RASS

Richmond agitation and sedation scale

ARDS

Acute respiratory distress syndrome

BIPAP

Biphasic positive airway pressure

CPAP–PS

Continuous positive airway pressure and pressure support

ISOdose

Dose of isoflurane per syringe pump in

ISOexp

Expiratory concentration of isoflurane

ISOinsp

Inspiratory concentration of isoflurane

ISOav

Average of the in- and expiratory concentration of isoflurane

Vt

Tidal volume

PMP

Polymethylpentene

PVC

Polyvinylchloride

Notes

Author contributions

AR had full access to the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. UH and CW assisted in collection of the data. UH, CW, PZ assisted in analysis and interpretation of the results. AR, PZ, TS, CW, UH contributed substantially to the study design, interpretation of the data and writing and critical revision of the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Ethics approval

Ethics committee of the Ruhr-University Bochum (Ethical committee number 17-6050 BR).

Consent for publication

Not applicable.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© The Japanese Society for Artificial Organs 2018

Authors and Affiliations

  1. 1.BG Universitätsklinikum Bergmannsheil, Klinik für Anästhesiologie, Intensiv-, Palliativ- und SchmerzmedizinBochumGermany
  2. 2.BG Universitätsklinikum Bergmannsheil, Klinik und Poliklinik für ChirurgieBochumGermany
  3. 3.Universität Duisburg-Essen, Medizinische FakultätEssenGermany

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