Evidence map›Paper›PMID 38536545›Full record

ArticleAnnals of intensive care2024

Early sevoflurane sedation in severe COVID-19-related lung injury patients. A pilot randomized controlled trial.

Beatrice Beck-Schimmer, Erik Schadde, Urs Pietsch, Miodrag Filipovic, Seraina Dübendorfer-Dalbert, Patricia Fodor, Tobias Hübner, Reto Schuepbach, Peter Steiger, Sascha David and 3 more

Erratum issued Registry-linked trialOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of intensive care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT04355962 (Sevoflurane Sedation in COVID-19 ARDS Patients to Reduce Lung Injury), which is not on this map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
3.4field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04355962 phase3completednot on this map

Sevoflurane Sedation in COVID-19 ARDS Patients to Reduce Lung Injury: a Randomized Controlled Trial

TypeinterventionalSponsorUniversity of ZurichRan2020 to 2021Enrolled68ConditionsARDS, Human, CoronavirusArmsSevoflurane, Intravenous drug
3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Review
  4. Inhaled sevoflurane in critically ill COVID-19 patients: A retrospective cohort study.Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) · 2026
    Article
  5. Volatile anesthetics in the intensive care unit.Anaesthesiology intensive therapy · 2025
    Review
  6. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 4 institutions in 2 countries.

Beatrice Beck-SchimmerInstitute of Anesthesiology, University Hospital Zurich University of Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland.
Erik SchaddeInstitute of Physiology, University of Zurich, Zurich, Switzerland.
Urs PietschDivision of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
Miodrag FilipovicDivision of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
Seraina Dübendorfer-DalbertInstitute of Anesthesia and Intensive Care Medicine, City Hospital Triemli, Zurich, Switzerland.
Patricia FodorInstitute of Anesthesia and Intensive Care Medicine, City Hospital Triemli, Zurich, Switzerland.
Tobias HübnerDepartment of Anesthesia and Intensive Care Medicine, Cantonal Hospital Muensterlingen, Muensterlingen, Switzerland.
Reto SchuepbachInstitute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Peter SteigerInstitute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Sascha DavidInstitute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Bernard D KrügerInstitute of Anesthesiology, University Hospital Zurich University of Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland.
Thomas A NeffDepartment of Anesthesia and Intensive Care Medicine, Cantonal Hospital Muensterlingen, Muensterlingen, Switzerland.
Martin SchläpferInstitute of Anesthesiology, University Hospital Zurich University of Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland. martin.schlaepfer@uzh.ch.ORCID http://orcid.org/0000-0003-4288-7124
University of Zurich · CHKantonsspital Münsterlingen · CHTriemli Hospital · CHUniversity of St.Gallen · CH

Funding

Promedica Stiftung n.a.Roche Diagnostics (CH) n.a.Sedana Medical Research Foundation n.a.Uniscientia Stiftung n.a.
6 · The paper itself

Abstract

backgroundThis study aimed to assess a potential organ protective effect of volatile sedation in a scenario of severe inflammation with an early cytokine storm (in particular IL-6 elevation) in patients suffering from COVID-19-related lung injury with invasive mechanical ventilation and sedation.

methodsThis is a small-scale pilot multicenter randomized controlled trial from four tertiary hospitals in Switzerland, conducted between April 2020 and May 2021. 60 patients requiring mechanical ventilation due to severe COVID-19-related lung injury were included and randomized to 48-hour sedation with sevoflurane vs. continuous intravenous sedation (= control) within 24 h after intubation. The primary composite outcome was determined as mortality or persistent organ dysfunction (POD), defined as the need for mechanical ventilation, vasopressors, or renal replacement therapy at day 28. Secondary outcomes were the length of ICU and hospital stay, adverse events, routine laboratory parameters (creatinine, urea), and plasma inflammatory mediators.

results28 patients were randomized to sevoflurane, 32 to the control arm. The intention-to-treat analysis revealed no difference in the primary endpoint with 11 (39%) sevoflurane and 13 (41%) control patients (p = 0.916) reaching the primary outcome. Five patients died within 28 days in each group (16% vs. 18%, p = 0.817). Of the 28-day survivors, 6 (26%) and 8 (30%) presented with POD (p = 0.781). There was a significant difference regarding the need for vasopressors (1 (4%) patient in the sevoflurane arm, 7 (26%) in the control one (p = 0.028)). Length of ICU stay, hospital stay, and registered adverse events within 28 days were comparable, except for acute kidney injury (AKI), with 11 (39%) sevoflurane vs. 2 (6%) control patients (p = 0.001). The blood levels of IL-6 in the first few days after the onset of the lung injury were less distinctly elevated than expected.

conclusionsNo evident benefits were observed with short sevoflurane sedation on mortality and POD. Unexpectedly low blood levels of IL-6 might indicate a moderate injury with therefore limited improvement options of sevoflurane. Acute renal issues suggest caution in using sevoflurane for sedation in COVID-19.

trial registrationThe trial was registered on ClinicalTrials.gov (NCT04355962) on 2020/04/21.

Indexed as

Anesthetic conditioningCOVID-19-related lung injurySevofluraneVolatile anesthetics

Identifiers

PMID38536545
PMCPMC10973324
OpenAlexW4393231562

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.