251: Standard Sedation and Sedation With Isoflurane in Mechanically Ventilated Patients With COVID-19

INTRODUCTION: Patients with COVID-19-induced ARDS commonly receive heavy sedation that is aimed at facilitating lung-protective mechanical ventilation and ensuring amnesia during paralysis The goal of the study was to quantify sedative drug utilization in a cohort of critically ill patients with COVID-19 and compare standard sedation with an alternative approach utilizing inhaled isoflurane METHODS: We retrospectively analyzed a cohort of mechanically ventilated patients with COVID-19 that were admitted to the intensive care unit at Massachusetts General Hospital between April 2 and May 4, 2020 Mechanical ventilation was delivered with Drager Apollo anesthesia machines The choice of sedatives, their dosing, and timing of initiation and discontinuation of isoflurane were at the discretion of ICU physicians Maximum inspired concentrations of isoflurane ranged between 0 2 and 1 1% Descriptive statistics were used to summarize demographics and clinical data P values were calculated using Chi-square test or Fisher's Exact test in categorical variables and Student's t test in continuous variables This analysis was approved by the Institutional Review Board RESULTS: Thirty-five mechanically ventilated patients were included in the study, with a mean (SD) age of 59 4 (12 8) years Twenty-three (65 7%) patients were men Seventeen (48 6%) patients received standard intravenous sedation, while 18 (51 4%) also received isoflurane The mean duration of mechanical ventilation (SD) was 23 3 (11 6) days in the standard sedation group and 23 8 (12 5) days in the isoflurane group Mean (SD) duration of isoflurane exposure was 5 61 (2 99) days, representing 29 1% of total sedation time (SD, 20 4) Cumulative opioid exposure did not differ between the standard sedation and isoflurane sedation groups (mean morphine milligram equivalent 6668 [SD, 1346] vs 6678 [SD, 2000] However, the initiation of isoflurane in patients was associated with decreased utilization of propofol (mean daily amount 3656[SD, 1635] before vs 950[SD,1804] during isoflurane, and hydromorphone (mean daily amount 48[SD, 30] before vs 23[SD, 27] during isoflurane CONCLUSIONS: In the subjects that received isoflurane, its initiation was associated with significant decreases in propofol and hydromorphone infusions