{"id":28034,"date":"2025-03-26T04:06:00","date_gmt":"2025-03-25T20:06:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=28034"},"modified":"2025-03-26T05:40:23","modified_gmt":"2025-03-25T21:40:23","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9aards%e6%82%a3%e8%80%85%e5%90%b8%e5%85%a5%e9%95%87%e9%9d%99%e8%8d%af%e7%89%a9","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=28034","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1aARDS\u60a3\u8005\u5438\u5165\u9547\u9759\u836f\u7269"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Caring for the Critically Ill Patient<\/p>\n\n\n\n

March 18, 2025<\/p>\n\n\n\n

Inhaled Sedation in Acute Respiratory Distress Syndrome: The SESAR Randomized Clinical Trial<\/h1>\n\n\n\n

Matthieu\u00a0Jabaudon,\u00a0Jean-Pierre\u00a0Quenot,\u00a0Julio\u00a0Badie,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>Published online March 18, 2025. doi:10.1001\/jama.2025.3169<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  Is a strategy of inhaled sedation with sevoflurane safe and associated with improved clinical outcomes in patients with acute respiratory distress syndrome compared with a strategy of intravenous sedation with propofol?<\/p>\n\n\n\n

Findings<\/strong>  In this randomized clinical trial that included 687 intensive care unit patients with moderate to severe acute respiratory distress syndrome, inhaled sedation with sevoflurane resulted in fewer ventilator-free days at 28 days and lower survival at 90 days than intravenous sedation with propofol.<\/p>\n\n\n\n

Meaning<\/strong>  These findings do not support a strategy of inhaled sedation with sevoflurane in critically ill patients with moderate to severe acute respiratory distress syndrome.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Whether the use of inhaled or intravenous sedation affects outcomes differentially in mechanically ventilated adults with acute respiratory distress syndrome (ARDS) is unknown.<\/p>\n\n\n\n

Objective<\/strong>  To determine the efficacy and safety of inhaled sevoflurane compared with intravenous propofol for sedation in patients with ARDS.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  Phase 3 randomized, open-label, assessor-blinded clinical trial conducted from May 2020 to October 2023 with 90-day follow-up. Adults with early moderate to severe ARDS (defined by a ratio of Pao2<\/sub> to the fraction of inspired oxygen of <150 mm Hg with a positive end-expiratory pressure of \u22658 cm H2<\/sub>O) were enrolled in 37 French intensive care units.<\/p>\n\n\n\n

Interventions<\/strong>  Patients were randomized to a strategy of inhaled sedation with sevoflurane (intervention group) or to a strategy of intravenous sedation with propofol (control group) for up to 7 days.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary end point was the number of ventilator-free days at 28 days; the key secondary end point was 90-day survival.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Of 687 patients enrolled (mean [SD] age, 65 [12] years; 30% female), 346 were randomized to sevoflurane and 341 to propofol. The median total duration of sedation was 7 days (IQR, 4 to 7) in both groups. The number of ventilator-free days through day 28 was 0.0 days (IQR, 0.0 to 11.9) in the sevoflurane group and 0.0 days (IQR, 0.0 to 18.7) in the propofol group (median difference, \u22122.1 [95% CI, \u22123.6 to \u22120.7]; standardized hazard ratio, 0.76 [95% CI, 0.50 to 0.97]). The 90-day survival rates were 47.1% and 55.7% in the sevoflurane and propofol groups, respectively (hazard ratio, 1.31 [95% CI, 1.05 to 1.62]). Among 4 secondary outcomes, sevoflurane was associated with higher 7-day mortality (19.4% vs 13.5%, respectively; relative risk, 1.44 [95% CI, 1.02 to 2.03]) and fewer intensive care unit\u2013free days through day 28 (median, 0.0 [IQR, 0.0 to 6.0] vs 0.0 [IQR, 0.0 to 15.0]; median difference, \u20132.5 [95% CI, \u20133.7 to \u20131.4]) compared with propofol.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Among patients with moderate to severe ARDS, inhaled sedation with sevoflurane resulted in fewer ventilator-free days at day 28 and lower 90-day survival than sedation with propofol.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT04235608<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Caring for the Critically […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28034"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=28034"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28034\/revisions"}],"predecessor-version":[{"id":28035,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28034\/revisions\/28035"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=28034"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=28034"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=28034"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}