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The New MIRUS System for Short-Term Sedation in Postsurgical ICU Patients
Stefano Romagnoli1, Cosimo Chelazzi, Gianluca Villa
11Department of Anesthesia and Intensive Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 2Industrial Hygiene Laboratory, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 3Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy. 4Department of Innovation, Quality and Control, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Objectives:
To evaluate the feasibility and safety of the MIRUS system (Pall International, Sarl, Fribourg, Switzerland) for sedation with sevoflurane for postsurgical ICU patients and to evaluate atmospheric pollution during sedation.
Design:
Prospective interventional study.
Setting:
Surgical ICU. February 2016 to December 2016.
Patients:
Postsurgical patients requiring ICU admission, mechanical ventilation, and sedation.
Interventions:
Sevoflurane was administered with the MIRUS system targeted to a Richmond Agitation Sedation Scale from -3 to -5 by adaptation of minimum alveolar concentration.
Measurements And Main Results:
Data collected included Richmond Agitation Sedation Scale, minimum alveolar concentration, inspired and expired sevoflurane fraction, wake-up times, duration of sedation, sevoflurane consumption, respiratory and hemodynamic data, Simplified Acute Physiology Score II, Sepsis-related Organ Failure Assessment, and laboratory data and biomarkers of organ injury. Atmospheric pollution was monitored at different sites: before sevoflurane delivery (baseline) and during sedation with the probe 15 cm up to the MIRUS system (S1) and 15 cm from the filter-Reflector group (S2). Sixty-two patients were enrolled in the study. No technical failure occurred. Median Richmond Agitation Sedation Scale was -4.5 (interquartile range, -5 to -3.6) with sevoflurane delivered at a median minimum alveolar concentration of 0.45% (interquartile range, 0.4-0.53) yielding a mean inspiratory and expiratory concentrations of 0.79% (SD, 0.24) and 0.76% (SD, 0.18), respectively. Median awakening time was 4 minutes (2.2-5 min). Median duration of sevoflurane administration was 3.33 hours (2.33-5.75 hr), range 1-19 hours with a mean consumption of 7.89 mL/hr (SD, 2.99). Hemodynamics remained stable over the study period, and no laboratory data indicated liver or kidney injury or dysfunction. Median sevoflurane room air concentration was 0.10 parts per million (interquartile range, 0.07-0.15), 0.17 parts per million (interquartile range, 0.14-0.27), and 0.15 parts per million (interquartile range, 0.07-0.19) at baseline, S1, and S2, respectively.
Conclusions:
The MIRUS system is a promising and safe alternative for short-term sedation with sevoflurane of ICU patients. Atmospheric pollution is largely below the recommended thresholds (< 5 parts per million). Studies extended to more heterogeneous population of patients undergoing longer duration of sedation are needed to confirm these observations.
Insights
The MIRUS system offers a safe and feasible method for short-term sevoflurane sedation in ICU patients, with minimal atmospheric pollution below recommended limits.
Area of Science:
- Anesthesiology
- Intensive Care Medicine
- Respiratory Therapy
Background:
- Postsurgical Intensive Care Unit (ICU) patients often require mechanical ventilation and sedation.
- Current sedation methods may have limitations in terms of safety and environmental impact.
- The MIRUS system presents a novel approach for volatile anesthetic delivery.
Purpose of the Study:
- To assess the feasibility and safety of the MIRUS system for sevoflurane sedation in postsurgical ICU patients.
- To evaluate the level of atmospheric pollution generated during MIRUS system sedation.
- To determine the efficacy of the MIRUS system in achieving target sedation levels.
Main Methods:
- Prospective interventional study conducted in a Surgical ICU from February to December 2016.
- Sevoflurane administration via the MIRUS system targeting a Richmond Agitation Sedation Scale (RASS) of -3 to -5.
- Monitoring of RASS, minimum alveolar concentration (MAC), sevoflurane concentrations, and atmospheric pollution levels.
Main Results:
- No technical failures were reported in 62 enrolled patients.
- The MIRUS system effectively achieved target sedation levels (median RASS -4.5) with sevoflurane at a median MAC of 0.45%.
- Median awakening time was 4 minutes, with stable hemodynamics and no evidence of organ injury. Atmospheric pollution remained below 0.2 parts per million, well under the 5 parts per million threshold.
Conclusions:
- The MIRUS system is a promising and safe alternative for short-term sevoflurane sedation in ICU patients.
- Atmospheric pollution levels during MIRUS system use are significantly below recommended safety thresholds.
- Further studies with heterogeneous populations and longer sedation durations are warranted to confirm these findings.
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