Clinical Scorecard: Inhaled Isoflurane as a Rescue Sedation Method for Critically Ill Pediatric Patients: A Retrospective Study in a Mixed Intensive Care Setting

At a Glance

Key Highlights

• Isoflurane reduced the median number of sedative agents from 4 to 3 (p < 0.001)
• Rescue medication use for breakthrough agitation declined from 100% to 42.9% (p < 0.001)
• Vasoactive-inotropic score increased from 6.22 to 9.70 (p = 0.008)
• Delirium occurred in 87.5% of survivors, and withdrawal in 44%
• Most patients were extubated within 24 hours after isoflurane cessation

Guideline-Based Recommendations

Diagnosis

• Consider isoflurane for rescue sedation when conventional sedation fails

Management

• Down-titrate concomitant intravenous sedatives while initiating isoflurane

Monitoring & Follow-up

• Vigilant hemodynamic monitoring is required due to potential cardiovascular instability

Risks

• Increased risk of delirium and withdrawal after prolonged use of isoflurane

Patient & Prescribing Data

Children aged 1 month to 18 years in a mixed PICU

Isoflurane serves as a rescue sedation strategy when conventional protocols are insufficient

Clinical Best Practices

• Assess sedation targets using the COMFORT-B score
• Consider contraindications such as neuromuscular diseases and severe hemodynamic instability before using isoflurane

Related Resources & Content

• Study on isoflurane in pediatric anesthesia