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Approach to Sedation and Analgesia in COVID-19 Patients on Venovenous Extracorporeal Membrane Oxygenation.
Dreucean, Diane; Harris, Jesse E; Voore, Prakruthi; Donahue, Kevin R.
  • Dreucean D; Houston Methodist Hospital, TX, USA.
  • Harris JE; Houston Methodist Hospital, TX, USA.
  • Voore P; Houston Methodist Hospital, TX, USA.
  • Donahue KR; Houston Methodist Hospital, TX, USA.
Ann Pharmacother ; 56(1): 73-82, 2022 01.
Article in English | MEDLINE | ID: covidwho-1197336
ABSTRACT

OBJECTIVE:

To describe clinically pertinent challenges of managing sedation in COVID-19 patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) and describe considerations for enhanced safety and efficacy of pharmacological agents used. DATA SOURCES A PubMed search was performed using the following search terms ECMO, ARDS, sedation, COVID-19, coronavirus, opioids, analgesia, fentanyl, hydromorphone, morphine, oxycodone, methadone, ketamine, propofol, dexmedetomidine, clonidine, benzodiazepines, midazolam, lorazepam, and diazepam. STUDY SELECTION AND DATA EXTRACTION Relevant clinical and pharmacokinetic studies were considered. All studies included were published between January 1988 and March 2021. DATA

SYNTHESIS:

Patients with acute respiratory distress syndrome secondary to COVID-19 may progress to requiring VV-ECMO support. Agents frequently used for sedation and analgesia in these patients have been shown to have significant adsorption to ECMO circuitry, leading to possible diminished clinical efficacy. Use of hydromorphone-based analgesia has been associated with improved clinical outcomes in patients on VV-ECMO. However, safety and efficacy regarding use of other agents in this patient population remains an area of further research. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review addresses clinical challenges associated with sedation management in COVID-19 patients requiring VV-ECMO support and provides potential strategies to overcome these challenges.

CONCLUSIONS:

Historically, sedation and analgesia management in patients requiring ECMO support have posed a challenge for bedside clinicians given the unique physiological and pharmacokinetic changes in this patient population. A multimodal strategy to managing analgesia and sedation should be used, and the use of enteral agents may play a role in reducing parenteral agent requirements.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Extracorporeal Membrane Oxygenation / COVID-19 / Analgesia Type of study: Prognostic study / Reviews Limits: Humans Language: English Journal: Ann Pharmacother Journal subject: Pharmacology / Drug Therapy Year: 2022 Document Type: Article Affiliation country: 10600280211010751

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Extracorporeal Membrane Oxygenation / COVID-19 / Analgesia Type of study: Prognostic study / Reviews Limits: Humans Language: English Journal: Ann Pharmacother Journal subject: Pharmacology / Drug Therapy Year: 2022 Document Type: Article Affiliation country: 10600280211010751