Inhaled Volatiles for Status Asthmaticus, Epilepsy, and Difficult Sedation in Adult ICU and PICU: A Systematic Review
OBJECTIVES:. Inhaled volatile anesthetics support management of status asthmaticus (SA), status epilepticus (SE), and difficult sedation (DS). This study aimed to evaluate the effectiveness, safety, and feasibility of using inhaled anesthetics for SA, SE, and DS in adult ICU and PICU patients. DATA...
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2024-02-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000001050 |
| _version_ | 1797292735584010240 |
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| author | Kevin Gorsky, MD Sean Cuninghame, MD Kesikan Jayaraj, RN Marat Slessarev, MD, PhD, FRCPC Conall Francoeur, MD Davinia E. Withington, BM, FRCA, MRCP(UK) Jennifer Chen Brian H. Cuthbertson, MBBS, PhD Claudio Martin, MD Martin Chapman, MD, FRCPC Saptharishi Lalgudi Ganesan, MBBS, MD, DM, FACNS Nicole McKinnon, MD, PhD Angela Jerath, MD, MSc, FANZCA, FRCPC on behalf of the SAVE-ICU Study Investigators Martin Chapman Damon Scales Julie Nardi Beth Linseman Phil Lau Boris Yakubov Eily Shaw Francois Carrier Emmanuel Charbonney Michaël Chassé Martin Girard Antoine Halwagi Guillaume Plourde Han Ting Wang Frédérick D’Aragon Maxime Tissot-Therrien François Lamontagne Dominique Bérard Yiorgos Alexandros Cavayas Martin Albert Francis Bernard Karim Serri David Williamson Virginie Williams Patricia Martinez Barrios Sabrina Araujo De Franca Etienne J. Couture Adreanne Côté Mathieu Simon Pierre-Alexis Lépine Dave Gleeton John Basmaji Marat Slessarev Ahmed Hegazy Tracey Bentall Eileen Campbell Michelle Stephens Tim Winterburn Roupen Hatzakorzian Kosar Khwaja Peter Goldberg Jason Shahin Jeremy Richard Grushka Jonathan Hooper Sherissa Microys Hilary Meggison David Leilipovitz Jessica Haines Irene Watpool Rebecca Porteous Stephanie Dunster Sylvie Bourbonnais Ewan Goligher Lorenzo Del Sorbo Niall Ferguson Philip Graham Michael Long Tina Yan Denise Morris Maria Kobylecky Hesham Abdelhady Tina Romagnuolo Bourke Tillman Ian Randall Elizabeth Wilcox Michael Jacka Oleksa Rewa Vincent Lau Sean Bagshaw Nadia Baig |
| author_facet | Kevin Gorsky, MD Sean Cuninghame, MD Kesikan Jayaraj, RN Marat Slessarev, MD, PhD, FRCPC Conall Francoeur, MD Davinia E. Withington, BM, FRCA, MRCP(UK) Jennifer Chen Brian H. Cuthbertson, MBBS, PhD Claudio Martin, MD Martin Chapman, MD, FRCPC Saptharishi Lalgudi Ganesan, MBBS, MD, DM, FACNS Nicole McKinnon, MD, PhD Angela Jerath, MD, MSc, FANZCA, FRCPC on behalf of the SAVE-ICU Study Investigators Martin Chapman Damon Scales Julie Nardi Beth Linseman Phil Lau Boris Yakubov Eily Shaw Francois Carrier Emmanuel Charbonney Michaël Chassé Martin Girard Antoine Halwagi Guillaume Plourde Han Ting Wang Frédérick D’Aragon Maxime Tissot-Therrien François Lamontagne Dominique Bérard Yiorgos Alexandros Cavayas Martin Albert Francis Bernard Karim Serri David Williamson Virginie Williams Patricia Martinez Barrios Sabrina Araujo De Franca Etienne J. Couture Adreanne Côté Mathieu Simon Pierre-Alexis Lépine Dave Gleeton John Basmaji Marat Slessarev Ahmed Hegazy Tracey Bentall Eileen Campbell Michelle Stephens Tim Winterburn Roupen Hatzakorzian Kosar Khwaja Peter Goldberg Jason Shahin Jeremy Richard Grushka Jonathan Hooper Sherissa Microys Hilary Meggison David Leilipovitz Jessica Haines Irene Watpool Rebecca Porteous Stephanie Dunster Sylvie Bourbonnais Ewan Goligher Lorenzo Del Sorbo Niall Ferguson Philip Graham Michael Long Tina Yan Denise Morris Maria Kobylecky Hesham Abdelhady Tina Romagnuolo Bourke Tillman Ian Randall Elizabeth Wilcox Michael Jacka Oleksa Rewa Vincent Lau Sean Bagshaw Nadia Baig |
| author_sort | Kevin Gorsky, MD |
| collection | DOAJ |
| description | OBJECTIVES:. Inhaled volatile anesthetics support management of status asthmaticus (SA), status epilepticus (SE), and difficult sedation (DS). This study aimed to evaluate the effectiveness, safety, and feasibility of using inhaled anesthetics for SA, SE, and DS in adult ICU and PICU patients.
DATA SOURCES:. MEDLINE, Cochrane Central Register of Controlled Trials, and Embase.
STUDY SELECTION:. Primary literature search that reported the use of inhaled anesthetics in ventilated patients with SA, SE, and DS from 1970 to 2021.
DATA EXTRACTION:. Study data points were extracted by two authors independently. Quality assessment was performed using the Joanna Briggs Institute appraisal tool for case studies/series, Newcastle criteria for cohort/case–control studies, and risk-of-bias framework for clinical trials.
DATA SYNTHESIS:. Primary outcome was volatile efficacy in improving predefined clinical or physiologic endpoints. Secondary outcomes were adverse events and delivery logistics. From 4281 screened studies, the number of included studies/patients across diagnoses and patient groups were: SA (adult: 38/121, pediatric: 28/142), SE (adult: 18/37, pediatric: 5/10), and DS (adult: 21/355, pediatric: 10/90). Quality of evidence was low, consisting mainly of case reports and series. Clinical and physiologic improvement was seen within 1–2 hours of initiating volatiles, with variable efficacy across diagnoses and patient groups: SA (adult: 89–95%, pediatric: 80–97%), SE (adults: 54–100%, pediatric: 60–100%), and DS (adults: 60–90%, pediatric: 62–90%). Most common adverse events were cardiovascular, that is, hypotension and arrhythmias. Inhaled sedatives were commonly delivered using anesthesia machines for SA/SE and miniature vaporizers for DS. Few (10%) of studies reported required non-ICU personnel, and only 16% had ICU volatile delivery protocol.
CONCLUSIONS:. Volatile anesthetics may provide effective treatment in patients with SA, SE, and DS scenarios but the quality of evidence is low. Higher-quality powered prospective studies of the efficacy and safety of using volatile anesthetics to manage SA, SE, and DS patients are required. Education regarding inhaled anesthetics and the protocolization of their use is needed. |
| first_indexed | 2024-03-07T20:01:44Z |
| format | Article |
| id | doaj.art-09dd4ac197df40d8a3e5362193889a15 |
| institution | Directory Open Access Journal |
| issn | 2639-8028 |
| language | English |
| last_indexed | 2024-03-07T20:01:44Z |
| publishDate | 2024-02-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj.art-09dd4ac197df40d8a3e5362193889a152024-02-28T06:47:24ZengWolters KluwerCritical Care Explorations2639-80282024-02-0162e105010.1097/CCE.0000000000001050202402000-00017Inhaled Volatiles for Status Asthmaticus, Epilepsy, and Difficult Sedation in Adult ICU and PICU: A Systematic ReviewKevin Gorsky, MD0Sean Cuninghame, MD1Kesikan Jayaraj, RN2Marat Slessarev, MD, PhD, FRCPC3Conall Francoeur, MD4Davinia E. Withington, BM, FRCA, MRCP(UK)5Jennifer Chen6Brian H. Cuthbertson, MBBS, PhD7Claudio Martin, MD8Martin Chapman, MD, FRCPC9Saptharishi Lalgudi Ganesan, MBBS, MD, DM, FACNS10Nicole McKinnon, MD, PhD11Angela Jerath, MD, MSc, FANZCA, FRCPC12on behalf of the SAVE-ICU Study InvestigatorsMartin ChapmanDamon ScalesJulie NardiBeth LinsemanPhil LauBoris YakubovEily ShawFrancois CarrierEmmanuel CharbonneyMichaël ChasséMartin GirardAntoine HalwagiGuillaume PlourdeHan Ting WangFrédérick D’AragonMaxime Tissot-TherrienFrançois LamontagneDominique BérardYiorgos Alexandros CavayasMartin AlbertFrancis BernardKarim SerriDavid WilliamsonVirginie WilliamsPatricia Martinez BarriosSabrina Araujo De FrancaEtienne J. CoutureAdreanne CôtéMathieu SimonPierre-Alexis LépineDave GleetonJohn BasmajiMarat SlessarevAhmed HegazyTracey BentallEileen CampbellMichelle StephensTim WinterburnRoupen HatzakorzianKosar KhwajaPeter GoldbergJason ShahinJeremy Richard GrushkaJonathan HooperSherissa MicroysHilary MeggisonDavid LeilipovitzJessica HainesIrene WatpoolRebecca PorteousStephanie DunsterSylvie BourbonnaisEwan GoligherLorenzo Del SorboNiall FergusonPhilip GrahamMichael LongTina YanDenise MorrisMaria KobyleckyHesham AbdelhadyTina RomagnuoloBourke TillmanIan RandallElizabeth WilcoxMichael JackaOleksa RewaVincent LauSean BagshawNadia Baig1 Department of Anesthesiology and Pain Management, University of Toronto, Toronto, ON, Canada.2 Department of Medicine, University of Western Ontario, London, ON, Canada.3 Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.2 Department of Medicine, University of Western Ontario, London, ON, Canada.5 Department of Pediatrics, Laval University Faculty of Medicine, QC, Canada.6 Department of Anesthesiology, McGill University Faculty of Medicine, Montreal, QC, Canada.7 Department of Medical Biophysics, University of Western Ontario, London, ON, Canada.1 Department of Anesthesiology and Pain Management, University of Toronto, Toronto, ON, Canada.2 Department of Medicine, University of Western Ontario, London, ON, Canada.1 Department of Anesthesiology and Pain Management, University of Toronto, Toronto, ON, Canada.4 Western Institute for Neuroscience, Western University, London, ON, Canada.10 Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada.1 Department of Anesthesiology and Pain Management, University of Toronto, Toronto, ON, Canada.OBJECTIVES:. Inhaled volatile anesthetics support management of status asthmaticus (SA), status epilepticus (SE), and difficult sedation (DS). This study aimed to evaluate the effectiveness, safety, and feasibility of using inhaled anesthetics for SA, SE, and DS in adult ICU and PICU patients. DATA SOURCES:. MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. STUDY SELECTION:. Primary literature search that reported the use of inhaled anesthetics in ventilated patients with SA, SE, and DS from 1970 to 2021. DATA EXTRACTION:. Study data points were extracted by two authors independently. Quality assessment was performed using the Joanna Briggs Institute appraisal tool for case studies/series, Newcastle criteria for cohort/case–control studies, and risk-of-bias framework for clinical trials. DATA SYNTHESIS:. Primary outcome was volatile efficacy in improving predefined clinical or physiologic endpoints. Secondary outcomes were adverse events and delivery logistics. From 4281 screened studies, the number of included studies/patients across diagnoses and patient groups were: SA (adult: 38/121, pediatric: 28/142), SE (adult: 18/37, pediatric: 5/10), and DS (adult: 21/355, pediatric: 10/90). Quality of evidence was low, consisting mainly of case reports and series. Clinical and physiologic improvement was seen within 1–2 hours of initiating volatiles, with variable efficacy across diagnoses and patient groups: SA (adult: 89–95%, pediatric: 80–97%), SE (adults: 54–100%, pediatric: 60–100%), and DS (adults: 60–90%, pediatric: 62–90%). Most common adverse events were cardiovascular, that is, hypotension and arrhythmias. Inhaled sedatives were commonly delivered using anesthesia machines for SA/SE and miniature vaporizers for DS. Few (10%) of studies reported required non-ICU personnel, and only 16% had ICU volatile delivery protocol. CONCLUSIONS:. Volatile anesthetics may provide effective treatment in patients with SA, SE, and DS scenarios but the quality of evidence is low. Higher-quality powered prospective studies of the efficacy and safety of using volatile anesthetics to manage SA, SE, and DS patients are required. Education regarding inhaled anesthetics and the protocolization of their use is needed.http://journals.lww.com/10.1097/CCE.0000000000001050 |
| spellingShingle | Kevin Gorsky, MD Sean Cuninghame, MD Kesikan Jayaraj, RN Marat Slessarev, MD, PhD, FRCPC Conall Francoeur, MD Davinia E. Withington, BM, FRCA, MRCP(UK) Jennifer Chen Brian H. Cuthbertson, MBBS, PhD Claudio Martin, MD Martin Chapman, MD, FRCPC Saptharishi Lalgudi Ganesan, MBBS, MD, DM, FACNS Nicole McKinnon, MD, PhD Angela Jerath, MD, MSc, FANZCA, FRCPC on behalf of the SAVE-ICU Study Investigators Martin Chapman Damon Scales Julie Nardi Beth Linseman Phil Lau Boris Yakubov Eily Shaw Francois Carrier Emmanuel Charbonney Michaël Chassé Martin Girard Antoine Halwagi Guillaume Plourde Han Ting Wang Frédérick D’Aragon Maxime Tissot-Therrien François Lamontagne Dominique Bérard Yiorgos Alexandros Cavayas Martin Albert Francis Bernard Karim Serri David Williamson Virginie Williams Patricia Martinez Barrios Sabrina Araujo De Franca Etienne J. Couture Adreanne Côté Mathieu Simon Pierre-Alexis Lépine Dave Gleeton John Basmaji Marat Slessarev Ahmed Hegazy Tracey Bentall Eileen Campbell Michelle Stephens Tim Winterburn Roupen Hatzakorzian Kosar Khwaja Peter Goldberg Jason Shahin Jeremy Richard Grushka Jonathan Hooper Sherissa Microys Hilary Meggison David Leilipovitz Jessica Haines Irene Watpool Rebecca Porteous Stephanie Dunster Sylvie Bourbonnais Ewan Goligher Lorenzo Del Sorbo Niall Ferguson Philip Graham Michael Long Tina Yan Denise Morris Maria Kobylecky Hesham Abdelhady Tina Romagnuolo Bourke Tillman Ian Randall Elizabeth Wilcox Michael Jacka Oleksa Rewa Vincent Lau Sean Bagshaw Nadia Baig Inhaled Volatiles for Status Asthmaticus, Epilepsy, and Difficult Sedation in Adult ICU and PICU: A Systematic Review Critical Care Explorations |
| title | Inhaled Volatiles for Status Asthmaticus, Epilepsy, and Difficult Sedation in Adult ICU and PICU: A Systematic Review |
| title_full | Inhaled Volatiles for Status Asthmaticus, Epilepsy, and Difficult Sedation in Adult ICU and PICU: A Systematic Review |
| title_fullStr | Inhaled Volatiles for Status Asthmaticus, Epilepsy, and Difficult Sedation in Adult ICU and PICU: A Systematic Review |
| title_full_unstemmed | Inhaled Volatiles for Status Asthmaticus, Epilepsy, and Difficult Sedation in Adult ICU and PICU: A Systematic Review |
| title_short | Inhaled Volatiles for Status Asthmaticus, Epilepsy, and Difficult Sedation in Adult ICU and PICU: A Systematic Review |
| title_sort | inhaled volatiles for status asthmaticus epilepsy and difficult sedation in adult icu and picu a systematic review |
| url | http://journals.lww.com/10.1097/CCE.0000000000001050 |
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