Lung protective characteristics of volatile anesthetic sedation

This narrative review serves as an update to previous reviews on the topic after the results of recent randomized controlled trials and meta-analyses. It describes some of the latest evidence around the use of volatile sedation as an alternative to intravenous sedation in mechanically ventilated patients in the intensive care unit (ICU) and their possible lung-protective properties. Preclinical evidence supporting an anti-inflammatory protective effect of volatile anesthetics suggests that volatile sedation could be employed in patients with inflammatory lung injury, including acute respiratory distress syndrome (ARDS). Large randomized controlled non-inferiority trials of isoflurane for general ICU sedation have suggested that it is effective, with no differences between groups in safety outcomes; however, the results of a recent RCT in patients with ARDS have demonstrated significant harm with the use of sevoflurane sedation. Therefore, the utility and safety of volatile sedation in patients with inflammatory lung injury, including ARDS, is now in question.