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

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.

Hemodynamic and respiratory effects of dexmedetomidine sedation in critically ill Covid‐19 patients: A retrospective cohort study

“…However, CV19 patients requiring invasive ventilation may have a high requirement for sedatives. 1 When patients are fighting the ventilator or require fully controlled ventilation to achieve adequate oxygenation, use of sedatives causing respiratory depression may be beneficial compared to sedatives with minimal effects on respiration (e.g., dexmedetomidine and ketamine). Due to the limited number of CV19 patients in our cohort, we were not able to compare the effects of dexmedetomidine to other sedatives.…”

“…Compared to traditional analgosedatives, dexmedetomidine has little effects on spontaneous respiration, which is usually ideal for respiratory compromised patients. However, CV19 patients requiring invasive ventilation may have a high requirement for sedatives 1 …”

“…Most available sedative drugs carry a risk for adverse reactions including respiratory depression, confusion, and circulatory depression, which may be harmful or even life‐threatening to the patient. 1 , 2 , 3 , 4 …”

“…Patients admitted to intensive care unit (ICU) for the Covid‐19 infection (CV19) usually require sedation to facilitate their respiratory work and ventilatory support. Most available sedative drugs carry a risk for adverse reactions including respiratory depression, confusion, and circulatory depression, which may be harmful or even life‐threatening to the patient 1–4 …”

COVİD-19 Kritik Hasta: Analjezi ve Sedasyon

“…Şiddetli akut hipoksi gelişen hastalar sıklıkla invaziv mekanik ventilasyona ihtiyaç duyulur. Bu durum etkili analjezi ve sedayon gerektirmektedir [3][4][5][6] . Bu hastalarda uygun sedasyon; hasta-ventilatör uyumsuzluğu, kazara ekstübasyonlar, devre bağlantılarının kesilmesi gibi problemleri önlediği gibi, refrakter hipoksik solunum yetmezliği olgularında prone pozisyon ve kas gevşetici uygulamalarını kolaylaştırır.…”