• Martin Bellgardt, Hagen Bomberg, Jenny Herzog-Niescery, Burkhard Dasch, Heike Vogelsang, Thomas P Weber, Claudia Steinfort, Waldemar Uhl, Stefan Wagenpfeil, Thomas Volk, and Andreas Meiser.
• From the Department of Anaesthesiology and Intensive Care Medicine, St. Josef Hospital, Katholisches Klinikum Bochum, University Hospital, Ruhr-University of Bochum, Bochum (MB, JH-N, BD, HV, TPW), Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Centre, Homburg/Saar (HB, TV, AM), Department of Visceral and General Surgery, Katholisches Klinikum Bochum, Ruhr-University of Bochum, Bochum (CS, WU), Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Centre, Homburg/Saar, Germany (SW).
• Eur J Anaesthesiol. 2016 Jan 1; 33 (1): 6-13.

BackgroundIsoflurane has shown better control of intensive care sedation than propofol or midazolam and seems to be a useful alternative. However, its effect on survival remains unclear.ObjectiveThe objective of this study is to compare mortality after sedation with either isoflurane or propofol/midazolam.DesignA retrospective analysis of data in a hospital database for a cohort of consecutive patients.SettingSixteen-bed interdisciplinary surgical ICU of a German university hospital.PatientsConsecutive cohort of 369 critically ill surgical patients defined within the database of the hospital information system. All patients were continuously ventilated and sedated for more than 96 h between 1 January 2005 and 31 December 2010. After excluding 169 patients (93 >79 years old, 10 <40 years old, 46 mixed sedation, 20 lost to follow-up), 200 patients were studied, 72 after isoflurane and 128 after propofol/midazolam.InterventionsSedation with isoflurane using the AnaConDa system compared with intravenous sedation with propofol or midazolam.Main Outcome MeasuresHospital mortality (primary) and 365-day mortality (secondary) were compared with the Kaplan-Meier analysis and a log-rank test. Adjusted odds ratios (ORs) [with 95% confidence interval (95% CI)] were calculated by logistic regression analyses to determine the risk of death after isoflurane sedation.ResultsAfter sedation with isoflurane, the in-hospital mortality and 365-day mortality were significantly lower than after propofol/midazolam sedation: 40 versus 63% (P = 0.005) and 50 versus 70% (P = 0.013), respectively. After adjustment for potential confounders (coronary heart disease, chronic obstructive pulmonary disease, acute renal failure, creatinine, age and Simplified Acute Physiology Score II), patients after isoflurane were at a lower risk of death during their hospital stay (OR 0.35; 95% CI 0.18 to 0.68, P = 0.002) and within the first 365 days (OR 0.41; 95% CI 0.21 to 0.81, P = 0.010).ConclusionCompared with propofol/midazolam sedation, long-term sedation with isoflurane seems to be well tolerated in this group of critically ill patients after surgery.

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