Use of Volatile Anesthetics for Long-Term Sedation In Critically Ill Patients
Overview
- Phase
- Not Applicable
- Intervention
- Propofol/midazolam
- Conditions
- Intubated Requiring Sedation for Greater Than 48 Hours
- Sponsor
- University Health Network, Toronto
- Enrollment
- 60
- Locations
- 2
- Primary Endpoint
- atmospheric volatile concentration
- Status
- Completed
- Last Updated
- 4 years ago
Overview
Brief Summary
Heavy sedation or sleep is a common problem within the intensive care unit (ICU) using our standard intravenous medications. This commonly leads to confusion, low blood pressure, slow wake up and removal of the artificial breathing tube (extubation), which prolongs ICU stay. Using inhaled volatile anesthetic agents are likely to improve these patient outcomes. This unique project is the first North American study looking at using volatiles for patients who need longer-term ICU sedation. This project has excellent potential at lowering these complications and improving quality of care, which will lower patient ICU stay and healthcare costs.
Investigators
Eligibility Criteria
Inclusion Criteria
- •adult ICU patients expected to be ventilated \> 48 hours
Exclusion Criteria
- •age \< 18 years
- •history of malignant hyperthermia
- •propofol infusion syndrome
- •evidence of raised intracranial pressure
- •6-month mortality risk from pre-existing condition \> 50%
- •lack of commitment to maximal treatment
- •NebulizedFlolan
- •tidal volume \<350ml
- •patients on one lung ventilation
Arms & Interventions
intravenous propofol/midazolam
Sedation using intravenous propofol/midazolam, sedation will be titrated to a Riker Agitation Sedation Score
Intervention: Propofol/midazolam
isoflurane
Sedation using inhaled isoflurane, sedation will be titrated to a Riker Agitation Sedation Score
Intervention: Isoflurane
Outcomes
Primary Outcomes
atmospheric volatile concentration
Time Frame: daily
Daily assessment of atmospheric volatile levels will be measured using photometric multigas infrared analyzer
Sedation
Time Frame: daily
adherence to the volatile sedation, sedation will be guided by explicit protocols targeting a Sedation-Agitation Score (SAS) of 3-4
Feasibility
Time Frame: 2 years
assess rate of patient recruitment and barriers to recruitment
Education Tool
Time Frame: 2 years
multidisciplinary feedback regarding teaching package, protocol, quality of sedation
serum fluoride levels
Time Frame: every 2 days
Measurements will be taken 24 hours post sedation and every 2 days until while on sedation followed by 2 further samples after discontinuation of sedation.