Volatile anesthetics for lung- and diaphragm-protective sedation

Müller-Wirtz LM, O’Gara B, Gama de Abreu M, Schultz MJ, Beitler JR, Jerath A, Meiser A (2024)

Publication Type: Journal article, Review article

Publication year: 2024

Journal

Critical Care BioMed Central

Book Volume: 28

Article Number: 269

Journal Issue: 1

DOI: 10.1186/s13054-024-05049-0

Abstract

This review explores the complex interactions between sedation and invasive ventilation and examines the potential of volatile anesthetics for lung- and diaphragm-protective sedation. In the early stages of invasive ventilation, many critically ill patients experience insufficient respiratory drive and effort, leading to compromised diaphragm function. Compared with common intravenous agents, inhaled sedation with volatile anesthetics better preserves respiratory drive, potentially helping to maintain diaphragm function during prolonged periods of invasive ventilation. In turn, higher concentrations of volatile anesthetics reduce the size of spontaneously generated tidal volumes, potentially reducing lung stress and strain and with that the risk of self-inflicted lung injury. Taken together, inhaled sedation may allow titration of respiratory drive to maintain inspiratory efforts within lung- and diaphragm-protective ranges. Particularly in patients who are expected to require prolonged invasive ventilation, in whom the restoration of adequate but safe inspiratory effort is crucial for successful weaning, inhaled sedation represents an attractive option for lung- and diaphragm-protective sedation. A technical limitation is ventilatory dead space introduced by volatile anesthetic reflectors, although this impact is minimal and comparable to ventilation with heat and moisture exchangers. Further studies are imperative for a comprehensive understanding of the specific effects of inhaled sedation on respiratory drive and effort and, ultimately, how this translates into patient-centered outcomes in critically ill patients. Graphical abstract: (Figure presented.)

Involved external institutions

Cleveland Clinic US United States (USA) (US) Beth Israel Deaconess Medical Center (BIDMC) US United States (USA) (US) Amsterdam University Medical Centers (Amsterdam UMC) / Amsterdam Universitair Medische Centra NL Netherlands (NL) New York Presbyterian Hospital US United States (USA) (US) University of Toronto CA Canada (CA) Universitätsklinikum des Saarlandes (UKS) DE Germany (DE)

How to cite

APA:

Müller-Wirtz, L.M., O’Gara, B., Gama de Abreu, M., Schultz, M.J., Beitler, J.R., Jerath, A., & Meiser, A. (2024). Volatile anesthetics for lung- and diaphragm-protective sedation. Critical Care, 28(1). https://doi.org/10.1186/s13054-024-05049-0

MLA:

Müller-Wirtz, Lukas M., et al. "Volatile anesthetics for lung- and diaphragm-protective sedation." Critical Care 28.1 (2024).

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