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
Submitted: 22 April 2021 Accepted: 31 May 2021
Online publish date: 29 June 2021
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
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