An examination of sedation requirements and practices for mechanically ventilated critically ill patients with COVID-19

作者：Aditi Balakrishna, Elisa C. Walsh, Arzo Hamidi, Sheri Berg, Daniel Austin, Richard M. Pino, Dusan Hanidziar, Marvin G. Chang, Edward A. Bittner · 发表于：American Journal of Health-System Pharmacy · 年份：2021 · DOI：10.1093/ajhp/zxab202 · 被引用次数：38 · 研究领域：Intensive Care Unit Cognitive Disorders、Long-Term Effects of COVID-19、COVID-19 Clinical Research Studies

PURPOSE: Preliminary reports suggest that critically ill patients with coronavirus disease 2019 (COVID-19) infection requiring mechanical ventilation may have markedly increased sedation needs compared with critically ill, mechanically ventilated patients without COVID-19. We conducted a study to examine sedative use for this patient population within multiple intensive care units (ICUs) of a large academic medical center. METHODS: A retrospective, single-center cohort study of sedation practices for critically ill patients with COVID-19 during the first 10 days of mechanical ventilation was conducted in 8 ICUs at Massachusetts General Hospital, Boston, MA. The study population was a sequential cohort of 86 critically ill, mechanically ventilated patients with COVID-19. Data characterizing the sedative medications, doses, drug combinations, and duration of administration were collected daily and compared to published recommendations for sedation of critically ill patients without COVID-19. The associations between drug doses, number of drugs administered, baseline patient characteristics, and inflammatory markers were investigated. RESULTS: Among the study cohort, propofol and hydromorphone were the most common initial drug combination, with these medications being used on a given day in up to 100% and 88% of patients, respectively. The doses of sedative and analgesic infusions increased for patients over the first 10 days, reaching or exceeding the upper limits of published ...