Sedating Mechanically Ventilated COVID-19 Patients with Volatile Anesthetics: Insights on the Last-Minute Potential Weapons

Abstract

Coronavirus Disease 2019 (COVID-19) has spread globally with the number of cases exceeding seventy million. Although trials on potential treatments of COVID-19 Acute Respiratory Distress Syndrome (ARDS) are promising, the introduction of an effective therapeutic intervention seems elusive. In this review, we explored the potential therapeutic role of volatile anesthetics during mechanical ventilation in the late stages of the disease. COVID-19 is thought to hit the human body via five major mechanisms: direct viral damage, immune overactivation, capillary thrombosis, loss of alveolar capillary membrane integrity, and decreased tissue oxygenation. The overproduction of pro-inflammatory cytokines will eventually lead to the accumulation of inflammatory cells in the lungs, which will lead to ARDS requiring mechanical ventilation. Respiratory failure resulting from ARDS is thought to be the most common cause of death in COVID-19. The literature suggests that these effects could be directly countered by using volatile anesthetics for sedation. These agents possess multiple properties that affect viral replication, immunity, and coagulation. They also have proven benefits at the molecular, cellular, and tissue levels. Based on the comprehensive understanding of the literature, short-term sedation with volatile anesthetics may be beneficial in severe stages of COVID-19 ARDS and trials to study their effects should be encouraged.

Pfizer-BioNTech and Sinopharm: A Comparative Study on Post-Vaccination Antibody Titers

“…This is corroborated with multiple studies that discover the effect of diabetes [25,26] and cardiovascular diseases on immunity [27]. Many things can affect the immune response towards COVID-19 and the titer of antibodies [28]. In COVID-19, the disease itself might become an immunosuppressant.…”

Documento de posicionamiento: uso de sedación inhalada en el paciente críticamente enfermo

“…Muy específicamente en pacientes con COVID-19 se debe establecer una meta específica del nivel de sedación para controlar la dosis. 27 Se ha comprobado que los agentes sedantes inhalados son seguros en los aspectos hemodinámicos, renales y hepáticos del paciente crítico y pueden jugar un aspecto incluso protector. 27 Se ha visto que tanto sevoflurano y desflurano reducen los niveles de macrófagos en el líquido alveolar, con disminución de citocinas, atenuando la respuesta inflamatoria, disminuyen la adhesión de los neutrófilos, fagocitosis y la generación de radicales de oxígeno, esto ayudando a la mejor respuesta ante la neumonía por COVID-19.…”

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“…In addition, some studies report various adverse effects of long-term inhaled anaesthetics such as dose-dependent respiratory depression, hypotension, malignant hyperthermia, diabetes insipidus and hepatitis, 9 among others. 10 Therefore, current randomised controlled trials will be helpful in establishing whether sedation with inhalational anaesthetics of critically ill patients with COVID-19 and other causes of respiratory failure is safe and improves patient and health system outcomes in comparison to traditional intravenous sedatives (eg, ClinicalTrials.gov, NCT04415060). While these trials will help to determine whether inhaled anaesthetics improve mortality and shorten duration of ventilation in patients with hypoxic respiratory failure, they will also assess the impact of inhaled sedatives on the quality-of-life measures after recovery from critical illness.…”

“…However, there may be practical limitations to using inhaled anaesthetics in the ICU including equipment and properly trained personnel. In addition, some studies report various adverse effects of long-term inhaled anaesthetics such as dose-dependent respiratory depression, hypotension, malignant hyperthermia, diabetes insipidus and hepatitis,9 among others 10. Therefore, current randomised controlled trials will be helpful in establishing whether sedation with inhalational anaesthetics of critically ill patients with COVID-19 and other causes of respiratory failure is safe and improves patient and health system outcomes in comparison to traditional intravenous sedatives (eg, ClinicalTrials.gov, NCT04415060).…”