Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. Kim L., Garg S., O’Halloran A., Whitaker M., Pham H., Anderson E.J., Armistead I., Bennett N.M., Billing L., Como-Sabetti K., et al. Risk Factors for Intensive Care Unit Admission and In-hospital Mortality Among Hospitalized Adults Identified through the US Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET) Clin. Infect. Dis. 2020;72:e206–e214. doi: 10.1093/cid/ciaa1012. - DOI - PMC - PubMed
    1. Di Castelnuovo A., Bonaccio M., Costanzo S., Gialluisi A., Antinori A., Berselli N., Blandi L., Bruno R., Cauda R., Guaraldi G., et al. Cardiovascular risk factors and in-hospital mortality in 3,894 patients with COVID-19: Survival analysis and machine learning-based findings from the multicentre Italian CORIST Study. Nutr. Metab. Cardiovasc. Dis. 2020;30:1899–1913. doi: 10.1016/j.numecd.2020.07.031. - DOI - PMC - PubMed
    1. Taccone F.S., Van Goethem N., De Pauw R., Wittebole X., Blot K., Van Oyen H., Lernout T., Montourcy M., Meyfroidt G., Van Beckhoven D. The role of organizational characteristics on the outcome of COVID-19 patients admitted to the ICU in Belgium. Lancet Reg. Health Eur. 2021;2:100019. doi: 10.1016/j.lanepe.2020.100019. - DOI - PMC - PubMed
    1. Chanques G., Constantin J.-M., Devlin J.W., Ely E.W., Fraser G.L., Gélinas C., Girard T.D., Guérin C., Jabaudon M., Jaber S., et al. Analgesia and sedation in patients with ARDS. Intensiv. Care Med. 2020;46:2342–2356. doi: 10.1007/s00134-020-06307-9. - DOI - PMC - PubMed
    1. Flinspach A.N., Booke H., Zacharowski K., Balaban U., Herrmann E., Adam E.H. High sedation needs of critically ill COVID-19 ARDS patients-A monocentric observational study. PLoS ONE. 2021;16:e0253778. doi: 10.1371/journal.pone.0253778. - DOI - PMC - PubMed

LinkOut - more resources