Sedation in the ICU relies on the use of a combination of intravenous hypnotics and opioids. Volatile anesthetics such as isoflurane or sevoflurane have been explored for sedation in ICU for a few years, based on their pharmacological properties. Even if early studies were promising, recent evidence raised concerns about higher mortality while using sevoflurane in ICU. This study aims to evaluate the impact of volatile sedation with Isoflurane within a real-world ICU setting.

Within a prospective data warehouse system (ReaSTOC), we screened patients receiving mechanical ventilation for more than 24 hours while being sedated for more than 12 hours. A cohort of 216 patients receiving volatile sedation (isoflurane) was matched with 432 patients sedated using intravenous drugs (midazolam and propofol).

ICU and hospital mortality rates were 40.6% and 43.5% in the volatile sedation group vs. 42.3% and 50.0% in intravenous sedation group (p-value 0.73 and 0.14, respectively). Major adverse events including acute kidney injury and dialysis were similar across both groups. Interestingly, ventilation duration and ICU length of stay were higher in volatile sedation group.

No difference in terms of mortality and adverse events occurrence was observed between intravenous and volatile sedation. These findings support the continued use of volatile sedation (isoflurane) in ICU settings.