• Critical patient
• ICU
• Inhaled sedation
• Mechanical ventilation
• Paciente crítico
• Sedación
• Sedación inhalada
• Sedation
• UCI
• Ventilación mecánica

• Humans
• Hypnotics and Sedatives/administration & dosage
• Critical Care/methods
• Critical Illness
• Respiration, Artificial
• Administration, Inhalation
• Delirium/prevention & control
• Anesthetics, Inhalation/administration & dosage
• Intensive Care Units
• Conscious Sedation/methods
• Isoflurane/administration & dosage
• Analgesia/methods
• Status Epilepticus/drug therapy
• Status Asthmaticus/drug therapy
• Respiratory Distress Syndrome/therapy
• Deep Sedation/methods
• Coronary Care Units
• Societies, Medical

• Awakening
• Cardiac Valve Prosthesis
• Cardiac surgery
• Critical care
• Management
• Volatile sedation

• Humans
• Propofol/therapeutic use
• Prospective Studies
• Cardiac Surgical Procedures/methods
• Critical Care/methods
• Airway Extubation
• Hypnotics and Sedatives/therapeutic use

• Sedana Medical Research Grant 2020 Sedana Medical SE
• Johann Wolfgang Goethe-Universität, Frankfurt am Main (1022)

• Inhalation sedation
• Intensive care unit
• Isoflurane
• Isoflurano
• Mechanical ventilation
• Sedación inhalada
• Sevoflurane
• Sevoflurano
• Unidad de Cuidados Intensivos
• Ventilación mecánica

• Adult
• Humans
• Hypnotics and Sedatives
• Intensive Care Units
• Respiration, Artificial
• Anesthesia
• Anesthetics, Inhalation

• Carbon footprint
• Environment
• General anesthesia
• Spinal anesthesia
• Transforaminal lumbar interbody fusion

Coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome (ARDS) is a severe complication of infection with severe acute respiratory syndrome coronavirus 2, and the primary cause of death in the current pandemic. Critically ill patients often undergo extracorporeal membrane oxygenation (ECMO) therapy as the last resort over an extended period. ECMO therapy requires sedation of the patient, which is usually achieved by intravenous administration of sedatives. The shortage of intravenous sedative drugs due to the ongoing pandemic, and attempts to improve treatment outcome for COVID-19 patients, drove the application of inhaled sedation as a promising alternative for sedation during ECMO therapy. Administration of volatile anesthetics requires an appropriate delivery. Commercially available ones are the anesthetic gas reflection systems AnaConDa^® and MIRUS^TM, and each should be combined with a gas scavenging system. In this review, we describe respiratory management in COVID-19 patients and the procedures for inhaled sedation during ECMO therapy of COVID-19 related ARDS. We focus particularly on the technical details of administration of volatile anesthetics. Furthermore, we describe the advantages of inhaled sedation and volatile anesthetics, and we discuss the limitations as well as the requirements for safe application in the clinical setting.

• Extracorporeal membrane oxygenation
• COVID-19
• Acute respiratory distress syndrome
• Critical care
• Volatile anesthetics
• Inhaled sedation

The MIRUS™ (TIM, Koblenz, Germany) is an electronical gas delivery system, which offers an automated MAC (minimal alveolar concentration)-driven application of isoflurane, sevoflurane, or desflurane, and can be used for sedation in the intensive care unit. We investigated its consumption of volatile anesthetics at 0.5 MAC (primary endpoint) and the corresponding costs. Secondary endpoints were the technical feasibility to reach and control the MAC automatically, the depth of sedation at 0.5 MAC, and awakening times. Mechanically ventilated and sedated patients after major surgery were enrolled. Upon arrival in the intensive care unit, patients obtained intravenous propofol sedation for at least 1 h to collect ventilation and blood gas parameters, before they were switched to inhalational sedation using MIRUS™ with isoflurane, sevoflurane, or desflurane. After a minimum of 2 h, inhalational sedation was stopped, and awakening times were recorded. A multivariate electroencephalogram and the Richmond Agitation Sedation Scale (RASS) were used to assess the depth of sedation. Vital signs, ventilation parameters, gas consumption, MAC, and expiratory gas concentrations were continuously recorded.

Thirty patients obtained inhalational sedation for 18:08 [14:46–21:34] [median 1st–3rd quartiles] hours. The MAC was 0.58 [0.50–0.64], resulting in a Narcotrend Index of 37.1 [30.9–42.4] and a RASS of − 3.0 [− 4.0 to (− 3.0)]. The median gas consumption was significantly lowest for isoflurane ([ml h⁻¹]: isoflurane: 3.97 [3.61–5.70]; sevoflurane: 8.91 [6.32–13.76]; and desflurane: 25.88 [20.38–30.82]; p < 0.001). This corresponds to average costs of 0.39 € h⁻¹ for isoflurane, 2.14 € h⁻¹ for sevoflurane, and 7.54 € h⁻¹ for desflurane. Awakening times (eye opening [min]: isoflurane: 9:48 [4:15–20:18]; sevoflurane: 3:45 [0:30–6:30]; desflurane: 2:00 [1:00–6:30]; p = 0.043) and time to extubation ([min]: isoflurane: 10:10 [8:00–20:30]; sevoflurane: 7:30 [4:37–14:22]; desflurane: 3:00 [3:00–6:00]; p = 0.007) were significantly shortest for desflurane.

A target-controlled, MAC-driven automated application of volatile anesthetics is technically feasible and enables an adequate depth of sedation. Gas consumption was highest for desflurane, which is also the most expensive volatile anesthetic. Although awakening times were shortest, the actual time saving of a few minutes might be negligible for most patients in the intensive care unit. Thus, using desflurane seems not rational from an economic perspective.

Trial registration Clinical Trials Registry (ref.: NCT03860129). Registered 24 September 2018—Retrospectively registered.

• Desflurane
• Inhalational sedation
• Isoflurane
• MAC-driven sedation
• Sevoflurane

• Airway
• Anesthesia
• Anesthesia equipment
• Depth of anesthesia
• Neurophysiologic monitoring

• Administration, Inhalation
• Conscious Sedation/methods
• Deep Sedation/methods
• Humans
• Hypnotics and Sedatives/administration & dosage
• Intensive Care Units
• Respiration, Artificial/methods