Sevoflurane sedation in COVID-19 acute respiratory distress syndrome: an observational study with a propensity score matching model

Guglielmo Consales; Iacopo Cappellini; Benedetta Freschi; Laura Campiglia; Maddalena Parise; Lucia Zamidei

doi:10.3389/fmed.2023.1267691

Sevoflurane sedation in COVID-19 acute respiratory distress syndrome: an observational study with a propensity score matching model

Front Med (Lausanne). 2023 Sep 15:10:1267691. doi: 10.3389/fmed.2023.1267691. eCollection 2023.

Authors

Guglielmo Consales¹, Iacopo Cappellini¹, Benedetta Freschi¹, Laura Campiglia¹, Maddalena Parise², Lucia Zamidei¹

Affiliations

¹ Department of Critical Care, Section of Anesthesiology and Critical Care Azienda USL Toscana Centro, Ospedale Santo Stefano, Prato, Italy.
² Anesthesia Unit, Castellanza Hospital, Multimedica Group, Milan, Italy.

Abstract

Introduction: The management of severe COVID-19-induced acute respiratory distress syndrome (C-ARDS) often involves deep sedation. This study evaluated the efficacy of sevoflurane, a volatile anesthetic, as an alternative to traditional intravenous sedation in this patient population.

Methods: This single-center, retrospective cohort study enrolled 112 patients with C-ARDS requiring invasive mechanical ventilation. A propensity score matching model was utilized to pair 56 patients receiving sevoflurane sedation with 56 patients receiving intravenous sedation. The primary outcome was mortality, with secondary outcomes being changes in oxygenation (PaO2/FiO2 ratio), pulmonary compliance, and levels of D-Dimer, CRP, and creatinine.

Results: The use of sevoflurane was associated with a statistically significant reduction in mortality (OR 0.40, 95% CI 0.18-0.87, beta = -0.9, p = 0.02). In terms of secondary outcomes, an increase in the PaO2/FiO2 ratio and pulmonary static compliance was observed, although the results were not statistically significant. No significant differences were noted in the levels of D-Dimer, CRP, and creatinine between the two groups.

Conclusion: Our findings suggest an association between the use of sevoflurane and improved outcomes in C-ARDS patients requiring invasive mechanical ventilation. However, due to the single-center, retrospective design of the study, caution should be taken in interpreting these results, and further research is needed to corroborate these findings. The study offers promising insights into potential alternative sedation strategies in the management of severe C-ARDS.

Keywords: COVID-19; acute respiratory distress syndrome (ARDS); inhalatory sedation; sedation; sevoflurane.

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article. This research received no external funding. The APC was funded by Sedana Medical.