Key result
Long-term sedation with isoflurane was associated with significantly lower in-hospital mortality compared to propofol or midazolam (40% vs 63%; OR 0.35; 95% CI 0.18-0.68; P=0.002).
Why the study?
Does sedation with isoflurane reduce mortality in critically ill surgical patients compared to intravenous sedation with propofol or midazolam?
Cohort (n=200)
No
Does sedation with isoflurane reduce mortality in critically ill surgical patients compared to intravenous sedation with propofol or midazolam?
Odds Ratio: 0.35 (95% CI 0.18–0.68)
Absolute Event Rate: 40% vs 63%
p-value: p=0.002
Long-term sedation with isoflurane in critically ill surgical patients is associated with significantly lower in-hospital and 1-year mortality compared to intravenous propofol or midazolam.
Isoflurane sedation should not yet change practice; hypothesis-generating for RCTs in surgical ICU patients.
BACKGROUND: Isoflurane has shown better control of intensive care sedation than propofol or midazolam and seems to be a useful alternative. However, its effect on survival remains unclear. OBJECTIVE: The objective of this study is to compare mortality after sedation with either isoflurane or propofol/midazolam. DESIGN: A retrospective analysis of data in a hospital database for a cohort of consecutive patients. SETTING: Sixteen-bed interdisciplinary surgical ICU of a German university hospital. PATIENTS: Consecutive cohort of 369 critically ill surgical patients defined within the database of the hospital information system. All patients were continuously ventilated and sedated for more than 96 h between 1 January 2005 and 31 December 2010. After excluding 169 patients (93 >79 years old, 10 <40 years old, 46 mixed sedation, 20 lost to follow-up), 200 patients were studied, 72 after isoflurane and 128 after propofol/midazolam. INTERVENTIONS: Sedation with isoflurane using the AnaConDa system compared with intravenous sedation with propofol or midazolam. MAIN OUTCOME MEASURES: Hospital mortality (primary) and 365-day mortality (secondary) were compared with the Kaplan-Meier analysis and a log-rank test. Adjusted odds ratios (ORs) [with 95% confidence interval (95% CI)] were calculated by logistic regression analyses to determine the risk of death after isoflurane sedation. RESULTS: After sedation with isoflurane, the in-hospital mortality and 365-day mortality were significantly lower than after propofol/midazolam sedation: 40 versus 63% (P = 0.005) and 50 versus 70% (P = 0.013), respectively. After adjustment for potential confounders (coronary heart disease, chronic obstructive pulmonary disease, acute renal failure, creatinine, age and Simplified Acute Physiology Score II), patients after isoflurane were at a lower risk of death during their hospital stay (OR 0.35; 95% CI 0.18 to 0.68, P = 0.002) and within the first 365 days (OR 0.41; 95% CI 0.21 to 0.81, P = 0.010). CONCLUSION: Compared with propofol/midazolam sedation, long-term sedation with isoflurane seems to be well tolerated in this group of critically ill patients after surgery.
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Bellgardt et al. (2015) conducted a cohort in Critically ill surgical patients (n=200). Isoflurane vs. Propofol or midazolam was evaluated on Hospital mortality (OR 0.35, 95% CI 0.18 to 0.68, p=0.002). Long-term sedation with isoflurane was associated with significantly lower in-hospital mortality compared to propofol or midazolam (40% vs 63%; OR 0.35; 95% CI 0.18-0.68; P=0.002).
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