Sedation with Sevoflurane versus Propofol in COVID-19 Patients with Acute Respiratory Distress Syndrome: Results from a Randomized Clinical Trial

Sara Martínez-Castro; Berta Monleón; Jaume Puig; Carolina Ferrer Gomez; Marta Quesada; David Pestaña; Alberto Balvis; Emilio Maseda; Alejandro Suárez de la Rica; Ana Monero Feijoo; Rafael Badenes

doi:10.3390/jpm13060925

Sedation with Sevoflurane versus Propofol in COVID-19 Patients with Acute Respiratory Distress Syndrome: Results from a Randomized Clinical Trial

J Pers Med. 2023 May 31;13(6):925. doi: 10.3390/jpm13060925.

Affiliations

¹ Department Anesthesiology, Surgical-Trauma Intensive Care and Pain Clinic, Hospital Clínic Universitari, University of Valencia, 46010 Valencia, Spain.
² Anesthesiology and Intensive Care Department, Consorcio Hospital General Universitario, 46014 Valencia, Spain.
³ Anesthesiology and Intensive Care Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain.
⁴ Surgical Critical Care Department, Hospital Universitario La Paz, 28046 Madrid, Spain.
⁵ Anesthesiology and Surgical Critical Care Department, Hospital Universitario De La Princesa, 28006 Madrid, Spain.

Abstract

Background: Acute respiratory distress syndrome (ARDS) related to COVID-19 (coronavirus disease 2019) led to intensive care units (ICUs) collapse. Amalgams of sedative agents (including volatile anesthetics) were used due to the clinical shortage of intravenous drugs (mainly propofol and midazolam).

Methods: A multicenter, randomized 1:1, controlled clinical trial was designed to compare sedation using propofol and sevoflurane in patients with ARDS associated with COVID-19 infection in terms of oxygenation and mortality.

Results: Data from a total of 17 patients (10 in the propofol arm and 7 in the sevoflurane arm) showed a trend toward PaO₂/FiO₂ improvement and the sevoflurane arm's superiority in decreasing the likelihood of death (no statistical significance was found).

Conclusions: Intravenous agents are the most-used sedative agents in Spain, even though volatile anesthetics, such as sevoflurane and isoflurane, have shown beneficial effects in many clinical conditions. Growing evidence demonstrates the safety and potential benefits of using volatile anesthetics in critical situations.

Keywords: COVID-19; acute respiratory distress syndrome; critical care; deep sedation; sevoflurane.

Grants and funding

This research received no external funding.