(966) Analgosedative Drug Use in Burn ICU Patients After Initiation of Inhaled Volatile-Based Sedation

Introduction: Introduction/Hypothesis: Sedation care in burns patients is complex and often necessitates the use of several intravenous sedatives at high doses. Sedative drug polypharmacy is associated with negative patient and health system outcomes like delirium and long ICU stays.
Volatile anesthetic based sedation was introduced as part of a new care pathway in burns patients during the SAVE ICU trial (CTN: NCT04415060). We aimed to evaluate the impact of inhaled anesthetics on sedation polypharmacy in ventilated burns patients.

Methods:

Methods: Ethics approved retrospective study of adult burns patients admitted to the Sunnybrook Health Sciences Center Ross Tilley Burns ICU between Jan 2021-May 2023. Patients on mechanical ventilation who received inhaled isoflurane were included. The primary outcome was a reduction in intravenous (IV) sedative use after commencing isoflurane. Daily drug dosing information for each patient was collected over 6 days of their ICU stay, beginning on the day prior to receiving isoflurane (day 0). Additional data extracted for analysis included patient demographics, comorbidities, burn severity, duration of hospital stay/ICU stay/ventilation and major ICU morbidities/mortality. Data was summarized using median (interquartile range, IQR) and frequency (%) for continuous and categorical variables.

Results:

Results: 28 patients were included with a median age of 36y, females 36%, 28% mean total burn surface area. Prior substance (54%) and alcohol misuse (36%) was high. Median ICU stay was 31 days with a median ventilation duration of 599h.
Prior to commencing isoflurane, the proportion of patients (median, IQR daily dose) on propofol was 48% (0, 0-1365mg), midazolam 88% (31, 4.5-61 mg), ketamine 92% (1610, 849.6-2312.4 mg), opioid 100% (morphine equivalents 263, 220-363.5 mg). Isoflurane use rose from 41 to 106 ml/day over 5 days. After starting isoflurane, the dose and proportion of patients on IV sedatives fell. On day 5, midazolam was used in 37% of patients (0, 0-3mg), ketamine 48% (0, 0-1118.4mg), propofol 0%. IV opioid dose fell by 18% by Day 5.

Conclusions:

Conclusions: Preliminary data shows that inhaled isoflurane can reduce sedative drug polypharmacy in burns patients. Further study is needed to evaluate whether this benefit translates into better patient outcomes.