Safe use of inhaled sedation in critically ill patients with invasive mechanical ventilation

Inhaled sedation uses halogenated drugs (isoflurane and sevoflurane) in a liquid state that, through a vaporizer, change to a gaseous state and reach the patient by the respiratory route. These drugs have a rapid onset of action, with minimal metabolism and elimination takes place almost exclusively through the airways. They do not cause significant tolerance, tachyphylaxis or significant abstinence. Inhaled sedation enables a rapid and more predictable awakening and reduced the need for opioids and neuromuscular relaxants (than intravenous sedation). In addition, have bronchodilatory, anticonvulsing and potential antiinflammatory and cardioprotective effects. To date, inhaled sedation has been practically exclusive to the areas of anesthesia and surgery. For its therapeutic application in the environment of the Intensive Care Units (ICU) there are two devices, Sedaconda ACD® and Mirus®. Its design, adaptable to different respirators and with a safe scavenging gas system, has facilitated its introduction in the ICUs. Scientific evidence supports the use of isoflurano and Sevoflurano (with limitations), especially in cases of moderate-deep sedation, and for people with acute respiratory distress syndrome, acute bronchospasm, status epilepticus, people who are difficult to sedate, prolonged sedation (only isoflurano) and patients post cardiac arrest or who need daily neurological assessment. Halogenated sedation is safe and effective for the critical patient undergoing mechanical ventilation. However, it is not exempt from risks and requires learning by professionals who will prescribe and/or apply. Nurses must know the characteristics of the drug, its handling, and be an expert in the route of administration so that the therapy is safe for the patient and health professionals.