Usefulness of Inhaled Sedation in Patients With Severe ARDS Due to COVID-19

Abstract

BACKGROUND: Sedation in intensive care is fundamental for optimizing clinical outcomes. For many years the world has been facing high rates of opioid use, and to combat the increasing opioid addiction plans at both national and international level have been implemented. 1 The COVID-19 pandemic posed a major challenge for health systems and also increased the use of sedatives and opioid analgesia for prolonged periods of time, and at high doses, in a significant proportion of patients. In our institutions, the shortage of many drugs for intravenous (IV) analgosedation forces us to alternatives to replace out-of-stock drugs or to seek sedation goals, which are difficult to obtain with traditional drugs at high doses. 2 METHODS: This was an analytical retrospective cohort study evaluating the follow-up of subjects with inclusion criteria from ICU admission to discharge (alive or dead). Five end points were measured: need for high-dose opioids (6 200 lg/h), comparison of inhaled versus IV sedation of opioid analgesic doses, midazolam dose, need for muscle relaxant, and risk of delirium. RESULTS: A total of 283 subjects were included in the study, of whom 230 were administered IV sedation and 53 inhaled sedation. In the inhaled sedation group, the relative risks (RRs) were 0.5 (95% CI 0.4-0.8, P 5 .045) for need of high-dose fentanyl, 0.3 (95% CI 0.20-0.45, P < .001) for need of muscle relaxant, and 0.8 (95% CI 0.61-1.15, P 5 .25) for risk of delirium. The median difference of fentanyl dose between the inhaled sedation and IV sedation groups was 61 lg/h or 1,200 lg/d (2.2 ampules/d, P < .001), and that of midazolam dose was 5.7 mg/h. CONCLUSIONS: Inhaled sedation was associated with lower doses of opioids, benzodiazepines, and muscle relaxants compared to IV sedation. This therapy should be considered as an alternative in critically ill patients requiring prolonged ventilatory support and where IV sedation is not possible, always under adequate supervision of ICU staff.

Roles of telocytes dominated cell–cell communication in fibroproliferative acute respiratory distress syndrome

“…75 Assisted ventilatory support, one of the important respiratory support measures for ARDS patients, could improve the progression of pulmonary fibrosis. 76 Recent research showed that the synthetic exertion and proliferation of TCs in atrium cordis tissue could respond to myocardial hemodynamic overload. 77 Moreover, TCs can change their shape, structure and mechanical properties in response to mechanical stress indicating its function under mechanical stretch.…”

“…The increased parenchymal stiffness of fibrotic lungs significantly affects respiratory mechanics, making the lung more fragile and prone to non‐physiological stress during spontaneous breathing and mechanical ventilation 75 . Assisted ventilatory support, one of the important respiratory support measures for ARDS patients, could improve the progression of pulmonary fibrosis 76 …”

Volatile Anesthetic Sedation for Critically Ill Patients

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