{"id":31949,"date":"2026-10-20T04:57:00","date_gmt":"2026-10-19T20:57:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=31949"},"modified":"2026-10-20T05:53:05","modified_gmt":"2026-10-19T21:53:05","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%8e%a5%e5%8f%97%e6%9c%ba%e6%a2%b0%e9%80%9a%e6%b0%94%e7%9a%84%e6%80%a5%e6%80%a7%e4%bd%8e%e6%b0%a7%e6%80%a7%e5%91%bc%e5%90%b8%e5%8a%9f%e8%83%bd","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=31949","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u63a5\u53d7\u673a\u68b0\u901a\u6c14\u7684\u6025\u6027\u4f4e\u6c27\u6027\u547c\u5438\u529f\u80fd\u8870\u7aed\u6210\u5e74\u60a3\u8005\u57fa\u4e8e\u5f02\u6c1f\u70f7\u7684\u5438\u5165\u9547\u9759"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

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

Isoflurane-Based Inhaled Sedation in Mechanically Ventilated Adults With Acute Hypoxemic Respiratory Failure: The SAVE-ICU Randomized Clinical Trial<\/h1>\n\n\n\n

Angela\u00a0Jerath,\u00a0Marat\u00a0Slessarev,\u00a0Claudio\u00a0Martin,\u00a0et al<\/h3>\n\n\n\n

JAMA Published Online:\u00a0October\u00a014,\u00a02026<\/h3>\n\n\n\n

doi: 10.1001\/jama.2026.18471<\/h3>\n\n\n\n

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

Question<\/strong>  Among mechanically ventilated adult patients with acute hypoxemic respiratory failure, does an inhaled sedation strategy using isoflurane with intravenous adjuncts as clinically needed reduce hospital mortality compared with usual intravenous sedation strategy?<\/p>\n\n\n\n

Findings<\/strong>  In this pragmatic, open-label, randomized clinical trial of 780 patients, there was no difference in hospital mortality risk between patients receiving inhaled sedation and those receiving intravenous sedation (42.5% vs 43.8%). Ventilator- and intensive care unit\u2013free days were similar between groups, as were measures of quality of life and disability scores.<\/p>\n\n\n\n

Meaning<\/strong>  Among mechanically ventilated patients with acute hypoxemic respiratory failure, an inhaled sedation strategy with predominantly isoflurane did not reduce hospital mortality compared with usual intravenous sedation.<\/a><\/p>\n\n\n\n

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

Importance<\/strong>\u00a0\u00a0Rigorous evidence for inhaled sedation using isoflurane in mechanically ventilated patients with acute hypoxemic respiratory failure (AHRF) is limited.<\/p>\n\n\n\n

Objective<\/strong>  To evaluate whether an inhaled sedation strategy lowers hospital mortality compared with usual care intravenous sedation strategy in mechanically ventilated adults with AHRF.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  Pragmatic, effectiveness, open-label, superiority, randomized clinical trial in 14 intensive care units (ICUs) in Canada. Adults (\u226518 years) receiving sedation for less than 72 hours and receiving mechanical ventilation for AHRF from non-COVID respiratory failure (ratio of partial pressure of arterial oxygen [Pao2<\/sub>] to fraction of inspired oxygen [Fio2<\/sub>] <300 mm Hg) or COVID-19 were enrolled between September 2020 and March 2025 with follow-up through June 2025.<\/p>\n\n\n\n

Intervention<\/strong>  Patients were randomized to an inhaled sedation strategy using isoflurane with intravenous adjuncts as clinically needed or to a usual intravenous sedation care strategy. Sedatives were titrated to achieve the desired target sedation score guided by clinical teams and continued until extubation or death.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  Primary outcome was all-cause hospital mortality. Secondary outcomes included ICU- and ventilator-free days at day 30; hospital-free days at day 60; use of refractory hypoxemia adjunctive therapies; delirium- and coma-free days at day 14; and quality-of-life and disability scores at 3 months.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Of 786 patients randomized, 780 were included in the primary analysis (mean age, 61.1 years; 34.0% female; 73.7% non-COVID AHRF, mean Pao2<\/sub>:Fio2<\/sub>\u00a0ratio, 152.6 mm Hg); 385 in the inhaled sedation and 395 in the intravenous sedation groups. In the inhaled sedation group, 49.9% to 55.4% of patients received concomitant intravenous sedation on any day during the first 14 days after randomization. At hospital discharge, 161 of 379 patients (42.5%) in the inhaled sedation group had died, compared with 171 of 390 patients (43.8%) in the intravenous sedation group (risk ratio, 0.98 [95% CI, 0.84 to 1.14];\u00a0P<\/em>\u2009=\u2009.85). There was no effect modification in prespecified subgroup analyses for age, sex, and COVID-19 status. ICU-, ventilator-, and hospital-free days were similar between groups. The inhaled sedation group received more adjunctive therapies for hypoxemia (239 [63.9%] vs 214 [55.0%]; between-group difference, 8.89% [95% CI, 1.95% to 15.83%]) and had fewer delirium- and coma-free days (between-group difference, \u22120.95 [95% CI, \u22121.69 to \u22120.22]). There was no difference in quality-of-life and disability scores between groups.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  In mechanically ventilated adults with AHRF, an inhaled sedation strategy using isoflurane with intravenous adjuncts as clinically needed did not reduce hospital mortality compared with an intravenous sedation strategy.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT04415060<\/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\/31949"}],"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=31949"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31949\/revisions"}],"predecessor-version":[{"id":31950,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31949\/revisions\/31950"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=31949"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=31949"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=31949"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}