Inhaled sedation with sevoflurane not beneficial in moderate-to-severe ARDS

In critically ill patients with moderate-to-severe acute respiratory distress syndrome (ARDS), inhaled sedation with sevoflurane may lead to fewer ventilator-free days at day 28 and lower 90-day survival compared with sedation with propofol, according to the results of the phase III SESAR study.

SESAR included 687 patients (mean age 65 years, 30 percent female) who had a ratio of Pao2 to the fraction of inspired oxygen of <150 mm Hg and a positive end-expiratory pressure of ≥8 cm H2O.

The patients were randomly assigned to a strategy of inhaled sedation with sevoflurane (intervention group, n=346) or to a strategy of intravenous sedation with propofol (control group, n=341) for up to 7 days. The median total duration of sedation was 7 days in both groups.

The primary endpoint of the number of ventilator-free days through day 28 did not significantly differ between the intervention group and the control group (median difference, −2.1, 95 percent confidence interval [CI], −3.6 to −0.7; standardized hazard ratio, 0.76, 95 percent CI, 0.50–0.97).

Survival rates at 90 days were 47.1 percent in the intervention group and 55.7 percent in the control group (hazard ratio [HR], 1.31, 95 percent CI, 1.05–1.62).

Compared with propofol, sevoflurane was associated with increased 7-day mortality (19.4 percent vs 13.5 percent; relative risk, 1.44, 95 percent CI, 1.02–2.03) and fewer intensive care unit–free days through day 28 (median, 0.0 vs 0.0; median difference, –2.5, 95 percent CI, –3.7 to –1.4).