Use of volatile anesthetics for sedation in the intensive care unit after the COVID-19 pandemic: a national survey in France. VOL'ICU 2 study
Abstract
Background: sedation is performed routinely in intensive care units (ICUs) to manage patients. Current sedation guidelines suggest strategies using non-benzodiazepine sedatives. The COVID-19 pandemic has suddenly increased the number of patients hospitalised in ICUs due to respiratory failure leading to a global shortage of the main intravenous sedative agents. Physicians had to find alternatives to intravenous sedation including inhaled sedation. The use of inhaled sedation in French ICU has been previously explored before the beginning of COVID-19 pandemic two years ago (VOL’ICU study). This survey was designed to explore and describe the use of inhaled sedation two years after the beginning of the COVID-19 pandemic and to evaluate how the pandemic has impacted the use of inhaled sedation by French physicians working in ICUs.
Methods: we designed a national survey, contacting medical directors of French ICUs by phone or email between June and September 2021. Over a 50-item questionnaire, the survey covered four categories: general characteristics of the ICU; general data of COVID-19 patients in ICU, general data on inhaled sedation, and the practical aspects of inhaled ICU sedation for both COVID-19 and non-COVID-19 patients. Some answers were compared with the previous survey, VOL’ICU.
Results: among the 405 ICUs contacted, a total of 27% (102/374) of the questionnaires were recorded (the 31 paediatric ICUs were excluded). Most ICU directors (87%, (89/102)) knew about the use of inhaled ICU sedation and 63% (56/89) of them has an inhaled sedation’s device in their unit, mostly the Anaesthetic Conserving Device (AnaConDa, Sedana Medical). The main indications to use inhaled sedation sustained by the respondents were “failure of intravenous sedation”, “severe asthma or bronchial obstruction”, and “acute respiratory distress syndrome”. Sevoflurane and isoflurane were mainly used (94% , (90/92) and 22%, (7/32) respectively). The main reasons for not using inhaled ICU sedation were “device not available” (76%, (47/62)), “lack of familiarity about the technique” (60%, (37/62)) and “no training for medical and paramedic team” (58%, (36/62) each). The COVID-19 pandemic increased the use of inhaled sedation in French ICUs. The main reasons said by the respondent to use inhaled sedation in COVID-19 patients were “need to additional sedative” (50%, (28/56)), “shortage of intravenous sedatives” (30%, (17/56)) and “involved in a clinical trial” (21%, (12/56)). More than 70% of respondents were overall satisfied with the use of inhaled sedation. Almost 80% of participants stated that inhaled sedation was a seducing alternative to intravenous sedation and to manage COVID-19 patients.
Conclusion: the use of inhaled sedation in ICU has increased quickly in the last 2 years, always with a good satisfaction among the users. Even if the COVID-19 pandemic could have impacted the widespread use of inhaled sedation, the use of inhaled sedation represents an alternative to intravenous sedation for more and more French physicians. Nonetheless, both lack of devices available in the units and insufficient training of ICU teams remains the two major restraining factors highlighting the importance of staff formation about inhaled sedation in ICU.
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