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. 2021 Nov 20;9(11):2393.
doi: 10.3390/microorganisms9112393.

Use of Sedatives and Neuromuscular-Blocking Agents in Mechanically Ventilated Patients with COVID-19 ARDS

Amédée Ego  1 , Lorenzo Peluso  1 , Julie Gorham  1 , Alberto Diosdado  1 , Giovanni Restuccia  1 , Jacques Creteur  1 , Fabio Silvio Taccone  1
Affiliations

Use of Sedatives and Neuromuscular-Blocking Agents in Mechanically Ventilated Patients with COVID-19 ARDS

Amédée Ego et al. Microorganisms. .

Abstract

Objectives: To assess differences in the use of analgesics, sedatives and neuromuscular-blocking agents (NMBA) in patients with acute respiratory distress syndrome (ARDS) due to COVID-19 or other conditions.

Methods: Retrospective observational cohort study, single-center tertiary Intensive Care Unit. COVID-19 patients with ARDS (March-May 2020) and non-COVID ARDS patients (2017-2020) on mechanical ventilation and receiving sedation for at least 48 h.

Results: A total of 39 patients met the inclusion criteria in each group, with similar demographics at baseline. COVID-19 patients had a longer duration of MV (median 22 (IQRs 16-29) vs. 9 (6-18) days; p < 0.01), of sedatives administration (18 (11-22) vs. 5 (4-9) days; p < 0.01) and NMBA therapy (12 (9-16) vs. 3 (2-7) days; p < 0.01). During the first 7 days of sedation, compared to non-COVID patients, COVID patients received more frequently a combination of multiple sedative drugs (76.9% vs. 28.2%; p < 0.01) and a higher NMBA regimen (cisatracurium: 3.0 (2.1-3.7) vs. 1.3 (0.9-1.9) mg/kg/day; p < 0.01).

Conclusions: The duration and consumption of sedatives and NMBA was significantly increased in patients with COVID-19 related ARDS than in non-COVID ARDS. Different sedation strategies and protocols might be needed in COVID-19 patients with ARDS, with potential implications on long-term complications and drugs availability.

Keywords: COVID-19; acute respiratory distress syndrome; neuromuscular-blocking agents; sedation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study.
Figure 2
Figure 2
Combination of sedatives, analgesics and neuromuscular-blocking agents. (A): Proportion of patients receiving a combination of sedatives. (B): Description of the combination of sedatives. (C): Duration of administration of Neuromuscular blocking agents (NMBA). (D): Cisatracurium administration regimen. P+M = Propofol + midazolam; P+M+A = Propofol + midazolam + alpha-2-agonist; P+K+A = Propofol + ketamine + alpha-2-agonist; P+K+M = Propofol + ketamine + midazolam; P+K+M+A = Propofol + ketamine + midazolam + alpha-2-agonist; Propofol + ketamine; M+A = Midazolam + alpha-2-agonist; M+K = Midazolam + ketamine; M+K+A = Midazolam + ketamine + alpha-2-agonist; P+A = Propofol + alpha-2-agonist.
Figure 3
Figure 3
Distribution of sedative use according to ARDS COVID-19 versus non-COVID-19 ARDS.
See this image and copyright information in PMC

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