Isoflurane-Based Inhaled Sedation in Mechanically Ventilated Adults With Acute Hypoxemic Respiratory Failure: The SAVE-ICU Randomized Clinical Trial.

Inhaled isoflurane sedation does not reduce hospital mortality compared to intravenous sedation in adults with acute hypoxemic respiratory failure.

• Why it matters: Limited evidence exists on the effectiveness of inhaled sedation with isoflurane in mechanically ventilated patients with AHRF, highlighting the need for rigorous trials to guide sedation practices.
• What they did: A randomized clinical trial involving 780 adults across 14 Canadian ICUs compared inhaled isoflurane with intravenous sedation, measuring hospital mortality and secondary outcomes such as ICU days and delirium.
• The result: Hospital mortality was similar between groups (42.5% vs 43.8%), and inhaled sedation was associated with increased adjunctive therapies for hypoxemia and fewer delirium- and coma-free days, indicating no mortality benefit.