Use of Inhaled Volatile Anesthetics for Longer Term Critical Care Sedation: A Pilot Randomized Controlled Trial
Bibliographic record
Abstract
Objectives: Assess feasibility, barriers to recruitment, and safety of volatile-based sedation in longer term sedation patients in North American ICUs with limited or no experience with volatile sedation. Design: Open-label, pilot randomized clinical trial performed between October 2013 and September 2018. Setting: Four Canadian ICUs across two academic tertiary and quaternary hospitals. Patients: Sixty adults anticipated needing sedation and invasive ventilation beyond 48 hours with tidal volumes greater than 350 mL, expected 6-month mortality risk less than 50%, no evidence of high intracranial pressure, or drug contraindications (malignant hyperthermia, allergy). Interventions: 2:1 randomization to inhaled volatile sedation using isoflurane or standard midazolam and/or propofol IV sedation. Measurement and Main Results: Primary outcome of safety and feasibility was assessed by staff satisfaction scores using a five-point Likert scale and serum fluoride measurements. Secondary clinical outcomes included time to extubation, quality of sedation, opioid use, cardiorespiratory parameters, vasopressor and antipsychotic drug use, and 3-month cognitive outcome measured using telephone interview for cognitive status. From 2,210 screened patients, 308 met eligibility criteria secondary to many not requiring sedation, extubation planned within 48 hours, high risk of death, or low tidal ventilation. Of 308 patients, 60 were randomized to isoflurane (n = 41) or IV (n = 19) sedation secondary to lack of substitute decision-maker or physician consent. Duration of inhaled isoflurane and IV sedation were median of 114 and 88 hours, respectively. Nine isoflurane patients crossed into the IV arm secondary to mainly hypercarbia from low tidal ventilation. Nursing and respiratory therapy staff satisfaction scores were quantitatively similar between both sedation approaches. Serum fluoride levels rose with duration of isoflurane sedation but were not associated with altered kidney function. There were no significant differences in secondary clinical outcomes. Conclusions: We showed adequate preliminary safety and acceptability of inhaled volatile anesthetics for long-term sedation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.007 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".