Early sevoflurane sedation in severe COVID-19-related lung injury patients. A pilot randomized controlled trial.

Early sevoflurane sedation in severe COVID-19-related lung injury patients. A pilot randomized controlled trial.

Publication date: Mar 27, 2024

This study aimed to assess a potential organ protective effect of volatile sedation in a scenario of severe inflammation with an early cytokine storm (in particular IL-6 elevation) in patients suffering from COVID-19-related lung injury with invasive mechanical ventilation and sedation. This is a small-scale pilot multicenter randomized controlled trial from four tertiary hospitals in Switzerland, conducted between April 2020 and May 2021. 60 patients requiring mechanical ventilation due to severe COVID-19-related lung injury were included and randomized to 48-hour sedation with sevoflurane vs. continuous intravenous sedation (= control) within 24 h after intubation. The primary composite outcome was determined as mortality or persistent organ dysfunction (POD), defined as the need for mechanical ventilation, vasopressors, or renal replacement therapy at day 28. Secondary outcomes were the length of ICU and hospital stay, adverse events, routine laboratory parameters (creatinine, urea), and plasma inflammatory mediators. 28 patients were randomized to sevoflurane, 32 to the control arm. The intention-to-treat analysis revealed no difference in the primary endpoint with 11 (39%) sevoflurane and 13 (41%) control patients (p = 0. 916) reaching the primary outcome. Five patients died within 28 days in each group (16% vs. 18%, p = 0. 817). Of the 28-day survivors, 6 (26%) and 8 (30%) presented with POD (p = 0. 781). There was a significant difference regarding the need for vasopressors (1 (4%) patient in the sevoflurane arm, 7 (26%) in the control one (p = 0. 028)). Length of ICU stay, hospital stay, and registered adverse events within 28 days were comparable, except for acute kidney injury (AKI), with 11 (39%) sevoflurane vs. 2 (6%) control patients (p = 0. 001). The blood levels of IL-6 in the first few days after the onset of the lung injury were less distinctly elevated than expected. No evident benefits were observed with short sevoflurane sedation on mortality and POD. Unexpectedly low blood levels of IL-6 might indicate a moderate injury with therefore limited improvement options of sevoflurane. Acute renal issues suggest caution in using sevoflurane for sedation in COVID-19. The trial was registered on ClinicalTrials. gov (NCT04355962) on 2020/04/21.

Concepts Keywords
April Anesthetic conditioning
Clinicaltrials Sevoflurane
Mortality Volatile anesthetics
Organ
Pilot

Semantics

Type Source Name
drug DRUGBANK Sevoflurane
disease MESH COVID-19
disease MESH lung injury
disease VO organ
disease MESH inflammation
disease MESH cytokine storm
drug DRUGBANK Creatinine
drug DRUGBANK Urea
disease MESH acute kidney injury
disease IDO blood

Original Article

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