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. 2023 Aug 31:10:1224242.
doi: 10.3389/fmed.2023.1224242. eCollection 2023.

The role of dexmedetomidine in ARDS: an approach to non-intensive care sedation

Francesca Simioli  1 , Anna Annunziata  1 , Antonietta Coppola  1 , Pasquale Imitazione  1 , Angela Irene Mirizzi  1 , Antonella Marotta  1 , Rossella D'Angelo  1 , Giuseppe Fiorentino  1
Affiliations

The role of dexmedetomidine in ARDS: an approach to non-intensive care sedation

Francesca Simioli et al. Front Med (Lausanne). .

Abstract

Introduction: Severe COVID-19 is a life-threatening condition characterized by complications such as interstitial pneumonia, hypoxic respiratory failure, and acute respiratory distress syndrome (ARDS). Non-pharmacological intervention with mechanical ventilation plays a key role in treating COVID-19-related ARDS but is influenced by a high risk of failure in more severe patients. Dexmedetomidine is a new generation highly selective α2-adrenergic receptor (α2-AR) agonist that provides sedative effects with preservation of respiratory function. The aim of this study is to assess how dexmedetomidine influences gas exchange during non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) in moderate to severe ARDS caused by COVID-19 in a non-intensive care setting.

Methods: This is a single center retrospective cohort study. We included patients who showed moderate to severe respiratory distress. All included subjects had indication to NIV and were suitable for a non-intensive setting of care. A total of 170 patients were included, divided in a control group (n = 71) and a treatment group (DEX group, n = 99).

Results: A total of 170 patients were hospitalized for moderate to severe ARDS and COVID-19. The median age was 71 years, 29% females. The median Charlson comorbidity index (CCI) was 2.5. Obesity affected 21% of the study population. The median pO2/FiO2 was 82 mmHg before treatment. After treatment, the increase of pO2/FiO2 ratio was clinically and statistically significant in the DEX group compared to the controls (125 mmHg [97-152] versus 94 mmHg [75-122]; ***p < 0.0001). A significative reduction of NIV duration was observed in DEX group (10 [7-16] days vs. 13 [10-17] days; *p < 0.02). Twenty four patients required IMV in control group (n = 71) and 16 patients in DEX group (n = 99) with a reduction of endotracheal intubation of 62% (OR 0.38; **p < 0.008). A higher incidence of sinus bradycardia was observed in the DEX group.

Conclusion: Dexmedetomidine provides a "calm and arousal" status which allows spontaneous ventilation in awake patients treated with NIV and HFNC. The adjunctive therapy with dexmedetomidine is associated with a higher pO2/FiO2, lower duration of NIV, and a lower risk of NIV failure. A higher incidence of sinus bradycardia needs to be considered.

Keywords: COVID-19; acute respiratory distress syndrome; continuous positive airway pressure; high flow nasal cannula; non-invasive ventilation; pressure support ventilation; refractory hypoxemia; respiratory drive.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Protocol intervention, inclusion/exclusion criteria.
Figure 2
Figure 2
pO2/FiO2 improved in DEX group; respiratory rate was comparable.
Figure 3
Figure 3
Non-invasive ventilation was needed for a shorter time in DEX group compared to controls. Invasive mechanical ventilation (IMV) rate was lower in DEX group.
See this image and copyright information in PMC

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