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Review
. 2021;11(2):107-115.
doi: 10.1007/s40140-021-00440-x. Epub 2021 Feb 26.

Challenges in Sedation Management in Critically Ill Patients with COVID-19: a Brief Review

Kunal Karamchandani  1 , Rajeev Dalal  1 , Jina Patel  2 , Puneet Modgil  3 , Ashley Quintili  2
Affiliations
Review

Challenges in Sedation Management in Critically Ill Patients with COVID-19: a Brief Review

Kunal Karamchandani et al. Curr Anesthesiol Rep. 2021.

Abstract

Purpose of review: To highlight the challenges associated with providing sedation and analgesia to critically ill patients with coronavirus disease 2019 (COVID-19) and also understand the pathophysiological alterations induced by the disease process as well as the logistical difficulties encountered by providers caring for these patients. We also discuss the rationale and risks associated with the use of common sedative agents specifically within the context of COVID-19 and provide evidence-based management strategies to help manage sedation and analgesia in such patients.

Recent findings: A significant proportion of patients with COVID-19 require intensive care and mechanical ventilation, thus requiring sedation and analgesia. These patients tend to require higher doses of sedative medications and often for long periods of time. Most of the commonly used sedative and analgesic agents carry unique risks that should be considered within the context of the unique pathophysiology of COVID-19, the logistical issues the disease poses, and the ongoing drug shortages.

Summary: With little attention being paid to sedation practices specific to patients with COVID-19 in critical care literature and minimal mention in national guidelines, there is a significant gap in knowledge. We review the existing literature to discuss the unique challenges that providers face while providing sedation and analgesia to critically ill patients with COVID-19 and propose evidence-based management strategies.

Keywords: Analgesia; COVID-19; Critically ill patients; SARS-CoV-2; Sedation.

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Conflict of interest statement

Conflict of InterestNone of the authors has any potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Medication options for analgesia and sedation in critically ill patients with COVID-19. COVID-19; coronavirus disease 2019; PRIS, propofol infusion syndrome; TG, triglyceride
Fig. 2
Fig. 2
Overview of sedation management in a critically ill mechanically ventilated patient with COVID-19. COVID-19, coronavirus disease 2019; RASS, Richmond Agitation Sedation Score
See this image and copyright information in PMC

References

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