ABSTRACT
INTRODUCTION: The COVID-19 pandemic has proliferated since the start of this year and has strained ICU resources globally. Far from an isolated respiratory illness, COVID-19 has multisystem effects, including pronounced neurological effects. Very little is known about critically ill patients and their sedation/analgesia requirements. We sought to quantify the sedation requirements for critically ill patients with COVID-19. METHODS: A prospective registry from 03/2020 to 06/2020 with COVID-19 at an urban tertiary care hospital was analyzed for intubated COVID-19 patients. Sedation data was abstracted for days 1,3,5,7,10,13,16,19,22,25, and 28 from the EMR, and infusion information was recorded as weighted average doses over a 24-hour period. Narcotics were reported as oral morphine equivalents (OMEs) and benzodiazepine doses were reported as midazolam equivalents (ME). A comparison was made to the placebo group of patients from the MIND-USA study as the median of the means. RESULTS: A total of 62 patients were analyzed with 55% African American, 33% Hispanic, 65% male, mean age of 58.5 years old, BMI of 33, and APACHE II score on ICU admission of 18.6. The median duration of mechanical ventilation was 9.5 days and an in-hospital mortality of 80.6%. Compared to the control arm of the MIND-USA study, the COVID-19 cohort had 2.89x higher propofol dose (TDD 4032 mg vs. 1391 mg), 5.5x higher precedex dose (TDD 3400mcg vs. 617mcg), 8.8x higher benzodiazepine dose (35 mg ME vs. 4 mg ME) and 1.79x higher OME dose (363 mg vs. 203 mg). The average infusions per patients was 2.42 and the most used infusions used were propofol (30% of patients per day) and precedex (25.8%). Approximately 17.6% of patients per day were receiving a paralytic infusion;however, a considerably greater share of patients (46.6% per day) were demonstrating quadriplegic paralysis. CONCLUSIONS: Critically ill patients with COVID-19 infection have significantly higher sedation/narcotic requirements than patients without COVID-19. This may be related to the underlying neurological effects of the virus and a potentially synergistic effect with sedation causing a high rate of quadriplegic paralysis. Further prospective trials are required to evaluate this hypothesis.