Intubated Requiring Sedation for Greater Than 48 Hours
Conditions
Keywords
Mechanical Ventilation, Volatile Sedation, Intravenous Sedation, Delirium
Brief summary
Heavy sedation or sleep is a common problem within the intensive care unit (ICU) using our standard intravenous medications. This commonly leads to confusion, low blood pressure, slow wake up and removal of the artificial breathing tube (extubation), which prolongs ICU stay. Using inhaled volatile anesthetic agents are likely to improve these patient outcomes. This unique project is the first North American study looking at using volatiles for patients who need longer-term ICU sedation. This project has excellent potential at lowering these complications and improving quality of care, which will lower patient ICU stay and healthcare costs.
Interventions
DRUGIsoflurane
DRUGPropofol/midazolam
Sponsors
University Health Network, Toronto
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* adult ICU patients expected to be ventilated \> 48 hours
Exclusion criteria
* age \< 18 years * history of malignant hyperthermia * propofol infusion syndrome * evidence of raised intracranial pressure * 6-month mortality risk from pre-existing condition \> 50% * lack of commitment to maximal treatment * pregnant * NebulizedFlolan * tidal volume \<350ml * patients on one lung ventilation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| atmospheric volatile concentration | daily | Daily assessment of atmospheric volatile levels will be measured using photometric multigas infrared analyzer |
| Sedation | daily | adherence to the volatile sedation, sedation will be guided by explicit protocols targeting a Sedation-Agitation Score (SAS) of 3-4 |
| Feasibility | 2 years | assess rate of patient recruitment and barriers to recruitment |
| Education Tool | 2 years | multidisciplinary feedback regarding teaching package, protocol, quality of sedation |
| serum fluoride levels | every 2 days | Measurements will be taken 24 hours post sedation and every 2 days until while on sedation followed by 2 further samples after discontinuation of sedation. |
Countries
Canada
Outcome results
None listed