Inhaled sevoflurane in critically ill COVID-19 patients: A retrospective cohort study

Background Managing sedation in critically ill COVID-19 patients is challenging due to high sedative requirements and organ dysfunction that alters drug metabolism. Inhaled sevoflurane offers a lung-eliminated alternative that may mitigate drug accumulation. Methods This single-center, retrospective cohort study analyzed 43 mechanically ventilated COVID-19 patients (March–November 2020). Patients received inhaled sevoflurane adjunctive to IV sedation (n=30) or IV sedation alone (n=13). The primary outcome was the cumulative dose of IV sedatives over 7 days. Secondary outcomes included time to extubation and antipsychotic use. Results There was no significant difference in the cumulative dose of IV sedatives between groups. However, the sevoflurane group had a significantly longer median duration of mechanical ventilation (206 [IQR 144–356] vs 144 [IQR 115–156] hours, p=0.005) and a higher requirement for antipsychotic medication (66.6% vs 15.3%, OR 18.6, p=0.011). Daily doses of propofol were lower in the sevoflurane group on specific days, but overall burden was unchanged. Conclusions In this cohort, adjunctive inhaled sevoflurane did not significantly reduce the cumulative burden of IV sedatives and was associated with delayed extubation and increased antipsychotic use. While sevoflurane is a feasible alternative, these findings suggest caution regarding weaning and delirium management in COVID-19 patients.