Volatile sedation using isoflurane versus intravenous sedation in intensive care unit: a propensity matched case control study
In brief
Isoflurane sedation yields ICU mortality of 41% versus 42% with IV drugs
In a propensity-matched study of 216 patients receiving isoflurane and 432 receiving midazolam/propofol, ICU and hospital death rates were essentially identical, and major complications such as kidney injury were comparable. However, patients sedated with isoflurane spent more days on the ventilator and longer in the ICU, suggesting safety but a potential trade-off in resource use.
- Journal
- Annals of intensive care (Q1)
- Published
- 16 July 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Romain Tymen, Kahaia De Longeaux, Pierre Bailly, Erwan L'Her
- PMID
- 42542586
- DOI
- 10.1016/j.aicoj.2026.100118
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (paper of the day, 3 August 2026).
Abstract
BACKGROUND: Sedation in the ICU relies on the use of a combination of intravenous hypnotics and opioids. Volatile anesthetics such as isoflurane or sevoflurane have been explored for sedation in ICU for a few years, based on their pharmacological properties. Even if early studies were promising, recent evidence raised concerns about higher mortality while using sevoflurane in ICU. This study aims to evaluate the impact of volatile sedation with Isoflurane within a real-world ICU setting. METHODS: Within a prospective data warehouse system (ReaSTOC), we screened patients receiving mechanical ventilation for more than 24 hours while being sedated for more than 12 hours. A cohort of 216 patients receiving volatile sedation (isoflurane) was matched with 432 patients sedated using intravenous drugs (midazolam and propofol). RESULTS: ICU and hospital mortality rates were 40.6% and 43.5% in the volatile sedation group vs. 42.3% and 50.0% in intravenous sedation group (p-value 0.73 and 0.14, respectively). Major adverse events including acute kidney injury and dialysis were similar across both groups. Interestingly, ventilation duration and ICU length of stay were higher in volatile sedation group. CONCLUSION: No difference in terms of mortality and adverse events occurrence was observed between intravenous and volatile sedation. These findings support the continued use of volatile sedation (isoflurane) in ICU settings.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.