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Available online 11 June 2024
Practical approach to inhaled sedation in the critically ill patient. Sedation, analgesia and Delirium Working Group (GTSAD) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC)
Abordaje práctico de la sedación inhalada en el paciente crítico. Grupo de Trabajo de Sedación, Analgesia y Delirium (GTSAD) de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC)
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Sofía Contrerasa,
Corresponding author
, Carola Giménez-Esparza Vichb, Jesús Caballeroc, on behalf of the Sedation, analgesia and Delirium Working Group (GTSAD) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC)
a Servicio de Medicina Intensiva, Hospital Universitario Vall d’Hebron, Barcelona, Spain
b Servicio de Medicina Intensiva, Hospital Vega Baja, Orihuela, Alicante, Spain
c Servicio de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
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Received 21 November 2023. Accepted 15 April 2024
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Abstract

The use of sedatives in Intensive Care Units (ICU) is essential for relieving anxiety and stress in mechanically ventilated patients, and it is related to clinical outcomes, duration of mechanical ventilation, and length of stay in the ICU. Inhaled sedatives offer benefits such as faster awakening and extubation, decreased total opioid and neuromuscular blocking agents (NMB) doses, as well as bronchodilator, anticonvulsant, and cardiopulmonary and neurological protective effects. Inhaled sedation is administered using a specific vaporizer. Isoflurane is the recommended agent due to its efficacy and safety profile. Inhaled sedation is recommended for moderate and deep sedation, prolonged sedation, difficult sedation, patients with acute respiratory distress syndrome (ARDS), status asthmaticus, and super-refractory status epilepticus. By offering these significant advantages, the use of inhaled sedatives allows for a personalized and controlled approach to optimize sedation in the ICU.

Keywords:
Inhaled sedation
Critical patient
ICU
Sedation
Mechanical ventilation
Resumen

El uso de sedantes en las Unidades de Cuidados Intensivos (UCI) es esencial para aliviar la ansiedad y el estrés en pacientes con ventilación mecánica (VM), y está relacionado con el resultado clínico, la duración de la VM y la estancia del paciente en UCI. Los sedantes inhalados ofrecen beneficios como un despertar y extubación más rápidos, disminución de la dosis total de opioides y de bloqueantes neuromusculares (BNM), además de tener efectos broncodilatadores, anticonvulsivantes y protectores cardiopulmonares y neurológicos. La sedación inhalada se administra mediante un vaporizador específico. El isoflurano es el agente recomendado debido a su perfil de eficacia y de seguridad. La sedación inhalada se recomienda en la sedación moderada y profunda, en la sedación prolongada, en la sedación difícil, en pacientes con síndrome de distrés respiratorio agudo (SDRA) estatus asmático y estatus epiléptico superrefractario. Al ofrecer estas ventajas significativas, el uso de sedantes inhalados permite un enfoque personalizado y controlado para optimizar la sedación en UCI.

Palabras clave:
Sedación inhalada
Paciente crítico
UCI
Sedación
Ventilación mecánica

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