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Sedation and Analgesic Requirements in Icu Patients with Covid-19: Planning for the Next Surge
Critical Care Medicine ; 51(1 Supplement):372, 2023.
Article in English | EMBASE | ID: covidwho-2190598
ABSTRACT

INTRODUCTION:

Increased use of sedatives and analgesics has been noted in patients with COVID-19 causing an increase in drug shortages. This study quantified sedative and analgesic requirements pre-COVID and during a COVID surge month. METHOD(S) This retrospective, single-center, cohort study included adult patients admitted to an ICU during January 2020, prior to the COVID-19 pandemic and January 2021, our local surge. Drugs that were examined were propofol, midazolam, dexmedetomidine and fentanyl. Continuous infusion and bolus doses were quantified whereby cumulative drug administered, frequency of use, average dose and duration of therapy were compared for each month (pre- COVID and COVID surge). RESULT(S) There were 454 patients included pre-COVID, n=262;COVID, n=192. During the COVID surge, more patients required mechanical ventilation (32% vs. 52%, p< 0.001) and renal replacement therapy (5% vs. 14%, p=0.001). During the COVID surge, midazolam requirements were 362% higher (14,682 vs. 53,128 mg) which was due to greater frequency (26% vs. 41%, p=0.001) and longer duration of use (36 [7-55] vs. 59 [20-124] h, p=0.015). The median dose was not different (4.5 [3-9] vs. 5.6 [3-9] mg/h, p=0.577). Dexmedetomidine requirements were 126% higher (97,721 vs. 123,806 mg). This was due to greater frequency (22% vs. 33%, p=0.006) and longer duration of use (14 [4-46] vs. 34 [12-60] h, p=0.32). The median dose was not different (0.4 [0.2-0.8] vs. 0.4 [0.2-0.8] mcg/kg/h, p=0.954). Fentanyl requirements were 352% higher (286,742 vs. 1,009,563 mcg). This was due to greater frequency (38% vs. 55%, p< 0.001) and longer duration of use (28 [11-74] vs. 58 [16-127] h, p=0.017). The median dose was not different (59 [47-116] vs. 87 [53-141] mcg/h, p=0.071). Conversely, the use of propofol was 22% less (469 vs. 364 g). There was no difference between the frequency of use (20% vs. 27%, p=0.087), duration of use (18 [6-59] vs. 20 [8-50] h, p=0.97) or median dose (34 [21-60] vs. 35 [20-63] mcg/kg/min, p=0.947). CONCLUSION(S) Sedative and analgesic use increased by more than 300% for some drugs during the COVID surge. This was primarily due to greater frequency of use and longer durations of therapy. Clinicians must consider these factors when planning for future surges to minimize drug shortages.
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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Critical Care Medicine Year: 2023 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Critical Care Medicine Year: 2023 Document Type: Article