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DOI
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Tailored sedation in critically ill COVID-19 patients based on lung damage, and pharmacokinetic and pharmacodynamic profiles
1DSC Anestesia e Rianimazione 2, IRCCS Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo (FG), Italy
2Multidisciplinary Emergency Unit for COVID-19 Campania, 80100 Naples, Italy
3Scientific Directorate, Istituto Nazionale Tumori "Fondazione G. Pascale"-IRCCS, 80133 Naples, Italy
4Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori-IRCCS-"Fondazione G. Pascale", 80131 Naples, Italy
DOI: 10.22514/sv.2021.115 Vol.17,Issue 6,November 2021 pp.157-161
Submitted: 22 April 2021 Accepted: 31 May 2021
Published: 08 November 2021
*Corresponding Author(s): Marco Cascella E-mail: m.cascella@istitutotumori.na.it
In critically ill COVID-19 patients, proper management of sedation is an important issue. Therefore, for this purpose, several strategies and protocols have been proposed. In this paper, we illustrate an approach focused on lung damage, and both the pharmacokinetic and pharmacodynamic profiles of drugs used. In line with this, during high flow nasal (HFN), continuous positive airway pressure, or non-invasive ventilation, dexmedetomidine-based light sedation can be helpful for maintaining the respiratory driving and improving the patient comfort. A worsening in the respiratory clinical picture with mechanical ventilation may require deep sedation with the use of clonidine. The latter may reduce the hypnotic doses, allowing improved hemodynamic stability. When respiratory performance improves, dexmedetomidine can replace clonidine to reduce the time to extubation.
COVID-19; Mechanical ventilation; Sedation; Propofol; Dexmedetomidine
Alfredo Del Gaudio,Giuseppe Mincolelli,Andreaserena Recchia,Elvio De Blasio,Maura C Tracey,Marco Cascella. Tailored sedation in critically ill COVID-19 patients based on lung damage, and pharmacokinetic and pharmacodynamic profiles. Signa Vitae. 2021. 17(6);157-161.
[1] Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Medicine. 2020; 46: 1099–1102.
[2] Alhazzani W, Belley-Cote E, Møller MH, Angus DC, Papazian L, Arabi YM, et al. Neuromuscular blockade in patients with ARDS: a rapid practice guideline. Intensive Care Medicine. 2020; 46: 1977–1986.
[3] Chanques G, Constantin J, Devlin JW, Ely EW, Fraser GL, Gélinas C, et al. Analgesia and sedation in patients with ARDS. Intensive Care Medicine. 2020; 46: 2342–2356.
[4] Mohammadi M, Ahmadi M, Khalili H, Cheraghchi H, Arbabi M. Cyproheptadine for the Prevention of Postoperative Delirium. Annals of Pharmacotherapy. 2016; 50: 180–187.
[5] Lin OA, Karim ZA, Vemana HP, Espinosa EV, Khasawneh FT. The antidepressant 5-HT2a receptor antagonists Pizotifen and cyproheptadine inhibit serotonin-enhanced platelet function. PLoS ONE. 2014; 9: e87026.
[6] Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Critical Care Medicine. 2018; 46: e825–e873.
[7] Paternoster G, Sartini C, Pennacchio E, Lisanti F, Landoni G, Cabrini L. Awake pronation with helmet continuous positive airway pressure for COVID-19 acute respiratory distress syndrome patients outside the ICU: a case series. Medicina Intensiva. 2020; S0210-5691(20)30273-4.
[8] Mehta S, Spies C, Shehabi Y. Ten tips for ICU sedation. Intensive Care Medicine. 2018; 44: 1141–1143.
[9] Cloesmeijer ME, Oever HLA, Mathôt RAA, Zeeman M, Kruis-dijk‐Gerritsen A, Bles CMA, et al. Optimising the dose of clonidine to achieve sedation in intensive care unit patients with population pharmacokinetics. British Journal of Clinical Pharmacology. 2020; 86: 1620–1631.
[10] Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine. Clinical Pharmacokinetics. 2017; 56: 893–913.
[11] Shafer SL, Hendrickx JFA, Flood P, Sonner J, Eger EI. Additivity versus synergy: a theoretical analysis of implications for anesthetic mechanisms. Anesthesia and Analgesia. 2008; 107: 507–524.
[12] Adams CD, Altshuler J, Barlow BL, Dixit D, Droege CA, Effendi MK, et al. Analgesia and Sedation Strategies in Mechanically Ventilated Adults with COVID-19. Pharmacotherapy. 2020; 40: 1180–1191.
[13] Buckley MS, Smithburger PL, Wong A, Fraser GL, Reade MC,
Klein-Fedyshin M, et al. Dexmedetomidine for Facilitating Mechanical Ventilation Extubation in Difficult-to-Wean ICU Patients: Systematic Review and Meta-Analysis of Clinical Trials. Journal of Intensive Care Medicine. 2020; 885066620937673.
[14] Jain A, Lamperti M, Doyle DJ. Dexmedetomidine: another arrow in the quiver to fight COVID-19 in intensive care units. British Journal of Anaesthesia. 2021; 126: e35–e38.
[15] Zhao H, Davies R, Ma D. Potential therapeutic value of dexmedetomidine in COVID-19 patients admitted to ICU. British Journal of Anaesthesia. 2021; 126: e33–e35.
[16] Cascella M, Mauro I, De Blasio E, Crispo A, Del Gaudio A, Bimonte S, et al. Rapid and Impressive Response to a Combined Treatment with Single-Dose Tocilizumab and NIV in a Patient with COVID-19 Pneumonia/ARDS. Medicina. 2020; 56: 377.
[17] Cascella M, Fiore M, Leone S, Carbone D, Napoli RD. Current controversies and future perspectives on treatment of intensive care unit delirium in adults. World Journal of Critical Care Medicine. 2019; 8: 18–27.
[18] Stockton J, Kyle-Sidell C. Dexmedetomidine and worsening hypoxemia in the setting of COVID-19: a case report. American Journal of Emergency Medicine. 2020; 38: 2247.e1–2247.e2.
[19] Czepiel KS, Lucas AT, Whalen MJ, Mojica JE. Dexmedetomidine-Associated Hyperpyrexia in Three Critically Ill Patients with Coronavirus Disease 2019. Critical Care Explorations. 2020; 2: e0213.
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