Stephanie Seto, PharmD
Massachusetts General Hospital
Boston, Massachusetts
Disclosure information not submitted.
Natasha Lopez, BCCCP, PharmD (she/her/hers)
Clinical Pharmacy Specialist, Medical Intensive Care Unit
Massachusetts General Hospital
Boston, Massachusetts
Disclosure information not submitted.
Arzo Hamidi, PharmD
Pharmacist
Rush University Medical Center
Chicago, Illinois
Disclosure information not submitted.
Russel Roberts, BCCCP, PharmD
Clinical Manager (Cardiology, Critical Care and Transplant Services)
Massachusetts General Hospital
Boston, Massachusetts, United States
Disclosure information not submitted.
Kristy Phillips, PharmD, BCCCP
Clinical Pharmacy Specialist, Critical Care
Massachusetts General Hospital, United States
Disclosure information not submitted.
Title: Impact of a Sedation and Analgesia Weaning Protocol in Critically Ill Patients with COVID-19
Introduction: Continuous infusion sedative and analgesic medications are frequently used in the management of mechanically ventilated patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate whether use of an algorithm, utilizing strategies to wean continuous infusions with or without intermittent dosing of replacement medications, resulted in faster liberalization from continuous benzodiazepine and opioid infusions.
Methods: A single-center, retrospective study was conducted in mechanically ventilated adult patients with ARDS due to COVID-19 infection who received ≥7 days of continuous infusion opioid and/or benzodiazepine. Patients who received replacement tapers (assisted taper; AT group) were matched 1:1 to patients who did not receive tapers (no assisted taper; NAT group) based on duration of mechanical ventilation prior to wean and SOFA score on admission.
Results: Time to discontinuation of continuous infusion opioid was 64 [32-156] and 49 [32-151] hours; p=0.95 in the AT and NAT groups, respectively. Time to discontinuation of continuous infusion benzodiazepine was 46 [27-76] in the AT group and the NAT group 26 [14-86] hours; p=0.22. There were no differences in duration of mechanical ventilation, ICU length of stay, and symptoms of withdrawal and pain.
Conclusions: There were no significant differences in time to discontinuation of continuous infusion opioids/benzodiazepines, duration of mechanical ventilation, ICU and hospital length of stay, and symptoms of pain and withdrawal between groups. Future studies are needed to further investigate the role of protocolized weaning strategies in critically ill patients with ARDS.