R222Use Of Volatile Agents For Sedation In The Intensive Care Unit: A National Survey In France

Réanimation / Urgences
Neuroscience
A. Quinson 1, R. Blondonnet 1, C. Lambert 2, J. Audard 2, T. Godet 1, R. Zhai 3, B. Pereira 1, E. Futier 2, J.E. Bazin 2, J.M. Constantin 4, M. Jabaudon 5.
1Chu Clermont-Ferrand, Université Clermont Auvergne-Clermont-Ferrand (france) - Clermont-Ferrand (France), 2Chu Clermont-Ferrand, Université Clermont Auvergne - Clermont-Ferrand (France) - Clermont-Ferrand (France), 3Gred, Cnrs, Inserm, Universite´ Clermont Auvergne - Clermont-Ferrand (France), 4Ho^pital Pitie´-Salpe^trie`re, Sorbonne Universite´ - Paris (France), 5Hu Clermont-Ferrand, Universite´ Clermont Auvergne, Vanderbilt University Medical Center - Clermont-Ferrand (France)

Conflits d'intérêt

The authors have no conflict of interest to declare.


Position du problème et objectif(s) de l’étude

Current intensive care unit (ICU) sedation guidelines recommend strategies using non-benzodiazepine sedatives. Since the development of halogenated anesthetic reflectors, suitable with modern critical care ventilators such as the Anaesthetic Conserving Device (AnaConDa, Sedana Medical, Uppsala, Sweden), inhaled sedation in the ICU has become increasingly popular. This survey was undertaken to explore the use of volatile agents for ICU sedation in France, to assess the indications and modalities of use selected by ICU care providers, and to understand the reasons for non-utilization if any.


Matériel et méthodes

National survey in France. Medical directors of French adult ICUs were contacted by phone or email between July and August 2019. ICU directors were questioned about the characteristics of their department, their knowledge on inhaled sedation, and practical aspects of inhaled sedation use in their department.


Résultats & Discussion

Among the 374 ICUs contacted, 187 provided responses (50%). Most ICU directors (73%) knew about the use of inhaled ICU sedation and 21% used inhaled sedation in their unit, mostly with the AnaConDa. Most respondents had used volatile agents for sedation for <5 years (63%) and in <20 patients per year (75%), with their main indications being: failure of intravenous sedation, severe asthma or bronchial obstruction, and acute respiratory distress syndrome. Sevoflurane and Isoflurane were mainly used (88% and 20%, respectively). The main reasons for not using inhaled ICU sedation were: “device not available” (40%), “lack of medical interest” (37%), “lack of familiarity or knowledge about the technique” (35%) and “elevated cost” (21%). Most respondents (80%) were overall satisfied with the use of inhaled sedation. Almost 75% stated that inhaled sedation was a seducing alternative to intravenous sedation.


Conclusion

This survey highlights the widespread knowledge about inhaled ICU sedation in France but shows its limited use to date. Differences in education and knowledge, as well as the recent and relatively scarce literature on the use of volatile agents in the ICU, might explain the diverse practices that were observed. The low rate of mild adverse effects, as perceived by respondents, and the users’ satisfaction, are promising for this potentially important tool for ICU sedation.


Références

Jabaudon M and al. Sevoflurane for Sedation in Acute Respiratory Distress Syndrome. A Randomized Controlled Pilot Study. Am J Respir Crit Care Med 2017; 195:792–800
Jerath A and al. Safety and Efficacy of Volatile Anesthetic Agents Compared With Standard Intravenous Midazolam/Propofol Sedation in Ventilated Critical Care Patients. Anesthesia & Analgesia 2017; 124:1190–1199


Remerciements

We wish to thank the directors and staff from participating intensive care units, the staff from the department of Biostatistical and Data Management Unit, Department of Clinical Research and Innovation, CHU Clermont-Ferrand, and from the Université Clermont Auvergne in Clermont-Ferrand, France.