Inhaled sedation in the A new option and its technical prerequisites
Andreas Meiser
Inhaled sedation in the A new option and its technical prerequisites - Homburg, Germany Springer Fachmedien Wiesbaden GmbH, part of Springer Nature 2019 - 58 Pages
Treatment of critically ill patients in the intensive care unit (ICU) is often
associated with unpleasant perceptions, especially if artificial ventilation is
interfering with natural breathing. To improve tolerance with the ventilator,
patients are routinely sedated with intravenous drugs. These sedative drugs
however have side effects, they accumulate in the body and this will slow
down their elimination afterwards. They may also cause organ dysfunction
and increase mortality.
On the search for alternatives, volatile anaesthetics (VA), especially halothane, isoflurane and sevoflurane, had been used successfully since the nineteen
fifties. Until recently, their use had however been limited because ICU ventilators are technically not designed for the application of VA and because
there was limited experience with effects of their long term use in humans.
Therefore we, the team of anaesthesiologists of the St. Josef-Hospital, RuhrUniversität Bochum, decided in the mid nineteen nineties to scientifically
examine the use of VA in the ICU.
At this time, gas scavenging was needed in order to be able to apply VA in
the ICU setting. Luckily, we were able to convince the hospital administration of the Katholisches Klinikum Bochum to equip the newly built surgical
ICU with such a gas scavenging system.
After elimination of this first hurdle, we found Dr. Meiser to be an ideal candidate, enthusiastic enough to take things in his own hands despite all presumed but yet unknown difficulties of the practical realization.
From the beginning, installing and performing inhaled sedation demanded
quite some improvisation from all team members, as well as additional monitoring and surveillance leading to increased workload. With enthusiasm,
Dr. Meiser took the challenge of sustained motivation of all team members,
to adopt the new therapeutic option whenever possible and sensible, and over
the years he gained a high recognition from staff.
In the late nineteen nineties, the first studies started under his direction in our
hospital, and in the early years of the third millennium the first randomized
controlled trial on inhaled sedation with desflurane was published in a highly
ranked journal. The introduction of the reflection principle for VA in 2004 simplified their
application in the ICU setting, and further increased acceptance by staff. VA
reflection on the one hand decreased consumption, and on the other hand it
made preinstalled active gas scavenging systems dispensable.
However, over the years, the technical realization of inhaled sedation seemed
like a series of pitfalls and new technical challenges. Therefore, with the
scientific cooperation of Professor Belda, Valencia, Spain, it was all the
more fruitful, by distributing the load of unexpected problems using further
scientific approaches.
The research project was slowed down in 2010 due to Dr. Meiser moving
from the St. Josef-Hospital Bochum to the University Hospital of the Saarland, Homburg, where the new method of inhaled sedation had to be introduced once more.
It is all the more admirable, that Dr. Meiser and his teams were meeting all
the new challenges and did not lose track of their goals. These goals may be
summarized up to now: scientific proof that the use of VA in critically ill
patients is not only economically viable but may also positively influence the
clinical management of the patients and may improve organ function.
On their way, Dr. Meiser and his teams have reached several interim goals,
and further successful results are in sight.
9783658273514 9783658273521
--Intensive care unit
Inhaled sedation in the A new option and its technical prerequisites - Homburg, Germany Springer Fachmedien Wiesbaden GmbH, part of Springer Nature 2019 - 58 Pages
Treatment of critically ill patients in the intensive care unit (ICU) is often
associated with unpleasant perceptions, especially if artificial ventilation is
interfering with natural breathing. To improve tolerance with the ventilator,
patients are routinely sedated with intravenous drugs. These sedative drugs
however have side effects, they accumulate in the body and this will slow
down their elimination afterwards. They may also cause organ dysfunction
and increase mortality.
On the search for alternatives, volatile anaesthetics (VA), especially halothane, isoflurane and sevoflurane, had been used successfully since the nineteen
fifties. Until recently, their use had however been limited because ICU ventilators are technically not designed for the application of VA and because
there was limited experience with effects of their long term use in humans.
Therefore we, the team of anaesthesiologists of the St. Josef-Hospital, RuhrUniversität Bochum, decided in the mid nineteen nineties to scientifically
examine the use of VA in the ICU.
At this time, gas scavenging was needed in order to be able to apply VA in
the ICU setting. Luckily, we were able to convince the hospital administration of the Katholisches Klinikum Bochum to equip the newly built surgical
ICU with such a gas scavenging system.
After elimination of this first hurdle, we found Dr. Meiser to be an ideal candidate, enthusiastic enough to take things in his own hands despite all presumed but yet unknown difficulties of the practical realization.
From the beginning, installing and performing inhaled sedation demanded
quite some improvisation from all team members, as well as additional monitoring and surveillance leading to increased workload. With enthusiasm,
Dr. Meiser took the challenge of sustained motivation of all team members,
to adopt the new therapeutic option whenever possible and sensible, and over
the years he gained a high recognition from staff.
In the late nineteen nineties, the first studies started under his direction in our
hospital, and in the early years of the third millennium the first randomized
controlled trial on inhaled sedation with desflurane was published in a highly
ranked journal. The introduction of the reflection principle for VA in 2004 simplified their
application in the ICU setting, and further increased acceptance by staff. VA
reflection on the one hand decreased consumption, and on the other hand it
made preinstalled active gas scavenging systems dispensable.
However, over the years, the technical realization of inhaled sedation seemed
like a series of pitfalls and new technical challenges. Therefore, with the
scientific cooperation of Professor Belda, Valencia, Spain, it was all the
more fruitful, by distributing the load of unexpected problems using further
scientific approaches.
The research project was slowed down in 2010 due to Dr. Meiser moving
from the St. Josef-Hospital Bochum to the University Hospital of the Saarland, Homburg, where the new method of inhaled sedation had to be introduced once more.
It is all the more admirable, that Dr. Meiser and his teams were meeting all
the new challenges and did not lose track of their goals. These goals may be
summarized up to now: scientific proof that the use of VA in critically ill
patients is not only economically viable but may also positively influence the
clinical management of the patients and may improve organ function.
On their way, Dr. Meiser and his teams have reached several interim goals,
and further successful results are in sight.
9783658273514 9783658273521
--Intensive care unit