Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Early and late effects of volatile sedation with sevoflurane on respiratory mechanics of critically ill COPD patients,” published in the June 2024 issue of Critical Care by Jung et al.

Researchers conducted a prospective study comparing the effects of sevoflurane and propofol on respiratory mechanics in critically ill patients with COPD experiencing an exacerbation.

They enrolled patients with critical illness who were intubated and experiencing severe exacerbations of COPD. A 1:1 randomization was employed to compare the effects of propofol and sevoflurane sedation. Key measurements include respiratory system mechanics (such as airway resistance, intrinsic positive end-expiratory pressure (PEEP), trapped volume, ventilatory ratio, and respiratory system compliance), gas exchange parameters, vital signs monitoring, safety assessments, and overall clinical outcomes. Data collection occurred at baseline upon inclusion and continued until 48 hours post-intervention (H48). The primary endpoint evaluated the total change in airway resistance from baseline to H48 in both treatment groups.

The result showed that 16 patients with critical illness received sedation with propofol for an average of 126 hours (61 to 228), while the sevoflurane group received for an average of 207 hours (171 to 216). No specific difference was observed in baseline average airway resistance in both groups as the propofol group had a baseline average airway resistance of 21.6 cmH₂O/L/s (19.8 to 21.6), while the sevoflurane group averaged 20.4 cmH₂O/L/s (18.6 to 26.4)(P=0.73). A significant variation (P=0.02) was observed in the trapped volume. The propofol group had a higher average trapped volume of 260 ml (176 to 290 ml) than the sevoflurane group’s average of 73 ml (35 to 126 ml). After optimizing external PEEP, both groups maintained similar intrinsic PEEP levels around 1.5 cmH₂O (1 to 3 cmH₂O). There are no specific differences in airway resistance or other respiratory mechanics parameters between the propofol and sevoflurane groups at either the early (4 hours) or late (48 hours) time points.

Investigators concluded that no significant difference was observed in respiratory mechanics between sevoflurane and propofol in critically ill patients with COPD who required ventilation.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01311-4