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Respir Med ; 189: 106667, 2021.
Article in English | MEDLINE | ID: covidwho-1487955


PURPOSE: Deep sedation is sometimes needed in acute respiratory distress syndrome. Ketamine is a sedative that has been shown to have analgesic and sedating properties without having a detrimental impact on hemodynamics. This pharmacological profile makes ketamine an attractive sedative, potentially reducing the necessity for other sedatives and vasopressors, but there are no studies evaluating its effect on these medications in patients requiring deep sedation for acute respiratory distress syndrome. MATERIALS AND METHODS: This is a retrospective, observational study in a single center, quaternary care hospital in southeast Texas. We looked at adults with COVID-19 requiring mechanical ventilation from March 2020 to September 2020. RESULTS: We found that patients had less propofol requirements at 72 h after ketamine initiation when compared to 24 h (median 34.2 vs 54.7 mg/kg, p = 0.003). Norepinephrine equivalents were also significantly lower at 48 h than 24 h after ketamine initiation (median 38 vs 62.8 mcg/kg, p = 0.028). There was an increase in hydromorphone infusion rates at all three time points after ketamine was introduced. CONCLUSIONS: In this cohort of patients with COVID-19 ARDS who required mechanical ventilation receiving ketamine we found propofol sparing effects and vasopressor requirements were reduced, while opioid infusions were not.

COVID-19/epidemiology , Deep Sedation , Hypnotics and Sedatives/administration & dosage , Ketamine/administration & dosage , Respiration, Artificial , Respiratory Distress Syndrome/epidemiology , Adult , Aged , Aged, 80 and over , Analgesics, Opioid/therapeutic use , COVID-19/therapy , Drug Utilization/statistics & numerical data , Female , Humans , Hydromorphone/therapeutic use , Male , Middle Aged , Norepinephrine/therapeutic use , Propofol/therapeutic use , Respiratory Distress Syndrome/therapy , Retrospective Studies , Texas/epidemiology
Respir Med ; 185: 106474, 2021.
Article in English | MEDLINE | ID: covidwho-1240604


Hypoxemic respiratory failure is a common manifestation of COVID-19 pneumonia. Early in the COVID-19 pandemic, patients with hypoxemic respiratory failure were, at times, being intubated earlier than normal; in part because the options of heated humidified high flow nasal cannula (HFNC) and non-invasive ventilation (NIV) were considered potentially inadequate and to increase risk of virus aerosolization. To understand the benefits and factors that predict success and failure of HFNC in this population, we evaluated data from the first 30 sequential patients admitted with COVID-19 pneumonia to our center who were managed with HFNC. We conducted Cox Proportional Hazards regression models to evaluate the factors associated with high flow nasal cannula failure (outcome variable), using time to intubation (censoring variable), while adjusting for comorbidities and immunosuppression. In the majority of our patients (76.7%), the use of HFNC failed and the patients were ultimately placed on mechanical ventilation. Those at increased risk of failure had a higher sequential organ failure assessment score, and at least one comorbidity or history of immunosuppression. Our data suggest that high flow nasal cannula may have a role in some patients with COVID-19 presenting with hypoxemic respiratory failure, but careful patient selection is the likely key to its success.

COVID-19/complications , Cannula/adverse effects , Noninvasive Ventilation/adverse effects , Oxygen Inhalation Therapy/adverse effects , Pandemics , Respiratory Insufficiency/therapy , Aged , Aged, 80 and over , COVID-19/epidemiology , Equipment Failure , Female , Humans , Male , Middle Aged , Noninvasive Ventilation/instrumentation , Oxygen Inhalation Therapy/instrumentation , Respiratory Insufficiency/etiology , SARS-CoV-2