The primary objective of this systematic review is to evaluate the anti-inflammatory effects of volatile sedative agents compared with intravenous sedative agents in adult surgical and critical care patients; in particular, their effects on pulmonary and systemic inflammation, and whether these effects correlate with clinically beneficial patient outcomes. Perioperative and critical care patients have an altered inflammatory response. Volatile agents, whether used in the operating room for anaesthesia or in the intensive care unit for sedation, exert measurable anti-inflammatory and immunomodulatory effects that may translate into beneficial clinical outcomes.

This systematic review aims to answer the following questions:

1. Do volatile anesthetics, compared with intravenous agents, reduce the pulmonary alveolar and/ or systemic inflammatory response in adult perioperative and critical care patients?
2. Is the use of volatile anaesthetics in the perioperative setting associated with a reduction in perioperative morbidity and mortality compared with intravenous agents, specifically in relation to adverse pulmonary events i.e., pneumonia, effusion, atelectasis, pulmonary oedema, ARDS and its causes?
3. Is the use of volatile anaesthetics for ICU sedation associated with improved morbidity and mortality in medical and surgical critical care patients (both cardiac and non-cardiac surgery)? Particularly in relation to sedation-ventilator and pulmonary outcomes i.e., duration of mechanical ventilation (including ventilator-free days), time to extubation, improved oxygenation (PaO2-FiO2 ratio), delirium, ICU stay (including ICU-free days), hospital stay.
4. Which specific inflammatory markers are involved in these clinical effects, and are they measurable in plasma and broncho-alveolar lavage fluid?

Ciara Hanley

Aggie Gao

Angela Jerath

Hira Raheel

Kevin Gorsky

Marat Slessarev

Sanchit Gupta

Soroush Rouhani

Coming soon