• Alexander Krannich, Christoph Leithner, Martin Engels, Jens Nee, Victor Petzinka, Tim Schröder, Achim Jörres, Jan Kruse, and Christian Storm.
• 1Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany.2Department of Neurology, Chariteé-Universitätsmedizin Berlin, Berlin, Germany.
• Crit. Care Med. 2017 Apr 1; 45 (4): e384-e390.

ObjectiveTargeted temperature management after cardiac arrest requires deep sedation to prevent shivering and discomfort. Compared to IV sedation, volatile sedation has a shorter half-life and thus may allow more rapid extubation and neurologic assessment.DesignObservational analysis of clinical data.SettingUniversity hospital, medical ICU.PatientsFour hundred thirty-two cardiac arrest survivors underwent targeted temperature management; of those, 110 were treated with volatile sedation using an anesthetic conserving device and isoflurane, and 322 received standard IV sedation.InterventionNo intervention.Measurement And Main ResultsA matched pairs analysis revealed that time on ventilator (difference of median, 98.5 hr; p = 0.003) and length of ICU stay (difference of median, 4.5 d; p = 0.006) were significantly shorter in patients sedated with isoflurane when compared with IV sedation although no differences in neurologic outcome (45% of patients with cerebral performance category 1-2 in both groups) were observed. Significant hypercapnia occurred more frequently during anesthetic conserving device use (6.4% vs 0%; p = 0.021).ConclusionsVolatile sedation is feasible in cardiac arrest survivors. Prospective controlled studies are necessary to confirm the beneficial effects on duration of ventilation and length of ICU stay observed in our study. Our data argue against a major effect on neurologic outcome. Close monitoring of PaCO2 is necessary during sedation via anesthetic conserving device.

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