SHS – Sunnybrook Medical Services Alternative Funding Plan Association
SHS-21-003 – A phase IV randomised, controlled, implementation trial of volatile based sedation in patients with COVID 19 (the ANACONDA study)
AFP funded a 50-patient pilot trial that introduced a new inhaled sedation care pathway for ventilated ICU COVID-19 patients. This was an original and rapidly implementable solution to improve outcomes for the sickest COVID patients in ICU given my early work has shown inhaled volatile drugs accelerate patient awakening and may reduce lung inflammation. Also, volatiles offered a cheap and safe way to manage ICU sedation during critical sedative drug shortages.
STATUS & OUTPUT
1. AFP recruitment was in 1-year across 3 sites as stipulated in the grant. Our work attracted funding from CIHR (project ranked 1st in 459 applications) and Ontario Government (total >$3 Million) to conduct a large clinical trial (SAVE-ICU) powered to relevant patient and health centred outcomes. SAVE-ICU is active in 15 centers and recruited > 200 patients. Active sub-studies include cost effectiveness, cognition and biomarkers. Several media outlets have profiled this unique project for e.g., CTV News, Financial Post, Sunnybrook Media.
2. We developed a new inter-disciplinary practice care pathway, protocols, dosing algorithms, education tools involving many stakeholders (MD, RN, RT, AA, pharmacy) to deliver volatiles in ICU. This process has been rolled out nationally.
3. This care pathway is original and unprecedented in North America, and not performed in America. Sunnybrook is a recognized centre of excellence. Our practice leaders for ICU nursing, respiratory therapy, anesthesia assistant have supported national teaching webinars.
4. Publications: Jerath A, Ferguson ND, Cuthbertson B. Inhalational volatile-based sedation for COVID-19 pneumonia and ARDS. ICM 2020 Jun 25:1-4; Gorsky K, Cuningham S, Chen J, et al. Use of volatile anesthetic agents in pediatric and adult ICU patients for status asthmaticus, status epilepticus and difficult sedation scenarios: A protocol for a systematic review. BMJ Open 2021(11):e051745; Cuninghame S, Gorsky K, Chen J, et al. The Effect of Sedation with Inhaled Anesthetics on Cognitive and Psychiatric Outcomes in Critically Ill Adults: A Systematic Review Protocol. BMJ open; In submission
5. Invited talks: 2020 Nov Health Canada: Volatile use in ICU. Advisory/consultation meeting 2020 Aug. Critical care volatile-based sedation. Centre hospitalier de l’Université de Montréal. Montréal, Canada. (Continuing Education). 2020 May. SedAting With Volatile Anesthetics Critically Ill COVID-19 Patients in ICU (SAVE-ICU trial): Effects On Ventilatory Parameters And Survival. Perioperative Anesthesia Clinical Trials (PACT) meeting. Canada. (Continuing Education). 2020 May. SedAting With Volatile Anesthetics Critically Ill COVID-19 Patients in ICU (SAVE-ICU trial): Effects On Ventilatory Parameters And Survival. Canadian Critical Care Trials Group (CCCTG) meeting. Canada. 2020 May. SedAting With Volatile Anesthetics Critically Ill COVID-19 Patients in ICU (SAVE-ICU trial): Effects On Ventilatory Parameters And Survival. Canadian Critical Care Research Co-ordinators Group (CCCRCG) meeting. Canada. (Continuing Education). 2020 Jul. Volatile-based Sedation for ICU Patients: Shifting the Paradigm in Sedation Care. Sunnybrook Health Science Center, Schulich Heart program Research Rounds, Sunnybrook Research Institute, Toronto, Ontario, Canada. 2020 Nov Key note. Volatile-based Sedation for ICU Patients: Shifting the Paradigm in Sedation Care. 41st Annual Shields Day, University of Toronto 2021 May Key note. Use of inhaled anesthetics as anti-inflammatories. International Anesthesia Research Society, United States.
6. 11 trainees from medical students to junior staff support SAVE-ICU in aligned studies. We believe and support diversity, equity and inclusion with >50% female and/or persons of color (BIPOC) trainees.
Risks and Complications
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