Rachel Kolar, BCCCP, PharmD
Critical Care Clinical Pharmacist
UNC Rex Health Care
Raleigh, North Carolina
Disclosure information not submitted.
Andreea Popa, BCCCP, BCPS, PharmD
MICU Clinical Pharmacy Specialist
University Hospitals Cleveland Medical Center
North Royalton, United States
Disclosure information not submitted.
Maroun Matta, MD
Clinical Assistant Professor, CWRU School of Medicine
University Hospitals Cleveland Medical Center, United States
Disclosure information not submitted.
Rana Hejal, MD
Medical Director, MICU, UH Cleveland Medical Center
University Hospitals Cleveland Medical Center, United States
Disclosure information not submitted.
Jessica Traeger, BCCCP, PharmD
Neuroscience ICU Pharmacy Clinical Specialist
University Hospitals Cleveland Medical Center Department of Pharmacy Services, United States
Disclosure information not submitted.
Olivia Kathryn Giddings, MD, PhD
Clinical Assistant Professor, CWRU School of Medicine
n/a, United States
Disclosure information not submitted.
Title: Sedation and Paralysis Requirements in Mechanically Ventilated Patients with COVID-19
Introduction: Management of severe acute respiratory distress syndrome (ARDS) secondary to COVID-19 often requires deep sedation and paralysis to maintain oxygen saturation goals. Anecdotal findings suggest that patients with COVID-19 require higher doses of sedative agents to achieve target levels of sedation and maintain ventilator synchrony. There is a large gap in the primary literature objectively quantifying the observed increases in sedation requirements in patients with COVID-19. The purpose of this study was to quantify the use of sedatives being utilized in mechanically ventilated COVID-19 patients as well as compare doses of sedative agents in the COVID group to a historical cohort of MICU patients without COVID-19.
Methods: The primary outcome was to quantify the use of sedatives and describe trends in COVID-specific inflammatory markers for mechanically ventilated patients with COVID. An additional endpoint included comparing doses of sedative agents in the COVID group to a historical cohort of MICU patients without COVID-19. Data was obtained for patients in the COVID group via a retrospective chart review between the dates of March 1, 2020 and September 1, 2020. Data for the non-COVID group was obtained via a retrospective chart review between January 1, 2017 through June 30, 2017. Due to the anticipated imbalances in sedation doses among groups, a sedation score was developed for comparison analysis.
Results: One-hundred seven patients were included (50 in the non-COVID group and 57 in the COVID group.) Patients in the COVID cohort received an average of 3 continuous sedative infusions. Medians (IQR) for COVID-inflammatory markers were 12.0 (5.3-20.5) for C-reactive protein, 4,176 (1,713-6,966) for d-dimer, 951 (538-1,992) for ferritin, 468 (338-689) for lactate dehydrogenase, and 1.0 (0.4-3.3) for procalcitonin.
Conclusions: When comparing composite sedation scores among the non-COVID and COVID group, patients in the COVID group had significantly higher composite sedation scores 3 (SD: 2) vs 5 (SD: 2), p< 0.001, when adjusted for age, weight, height, gender, race, hospital LOS, and ICU length of stay. It was concluded that higher daily doses of sedative agents were used in COVID-19 patients compared to non-COVID patients.