Sedation, narcotic and neuromuscular blockade in mechanically ventilated patients with COVID-19

Abstract

Objective: To describe the sedation, narcotic and neuromuscular blockade usage in ventilated patients with COVID-19 pneumonia.

Design: Single-Center Retrospective Review.

Setting: George Washington University Hospital in Washington, D.C.

Patients: 62 patients with COVID-19 respiratory failure requiring mechanical ventilation admitted from March 2020 to June 2020.

Intervention: None.

Measurements and main results: Patients with COVID-19 respiratory failure required multiple sedative/narcotic infusions to achieve sedation requirements and at doses that were significantly more when compared to a general medical-surgical ICU population (represented by the MIND-USA cohort). The most common infusions were Dexmedetomadine and Propofol. Approximately 17% of our patients required a neuromuscular blockade infusion as well. Prior to intubation, narcotic utilization was stable and low.

Conclusion: Patients with COVID-19 respiratory failure requiring mechanical ventilation have higher sedation and narcotic requirements than general ICU patients.

Keywords: Analgesia; COVID-19; Mechanical ventilation; Neuromuscular blockade; Sedation.

Fig. 1

Narcotic utilization in intubated patients in the days preceding intubation and the days following intubation. Narcotic rates remained stable in the pre-intubation period and use increased dramatically following intubation.