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SELF-EXTUBATION RATE AND SEDATION REQUIREMENT IN COVID-19
Chest ; 158(4):A634, 2020.
Article in English | EMBASE | ID: covidwho-860847
ABSTRACT
SESSION TITLE Critical Care Posters SESSION TYPE Original Investigation Posters PRESENTED ON October 18-21, 2020

PURPOSE:

After the novel coronavirus disease (COVID-19), was declared a pandemic, New York quickly became the new epicenter of the disease. This study was conducted during the peak of COVID-19 in Queens. Many COVID-19 patients with severe acute respiratory distress syndrome (ARDS) required endotracheal intubation and heavy sedation for prolonged periods of time. Unplanned extubation (UE) events have a notable impact on clinical course and outcome. [1] Self-extubation (SE) is the most common reason for UE, and inadequate sedation is one of its most significant risk factors. [1,2] This study examines factors associated with SE events in patients with ARDS in COVID-19.

METHODS:

At a single acute tertiary care hospital located in Queens, New York, all patients with SARS-CoV-2 infection admitted between March 15, 2020 and April 15, 2020, were screened. Active COVID-19 status was confirmed with reverse transcriptase-polymerase chain reaction assay performed on nasopharyngeal samples. All patients who underwent endotracheal intubation were included in the study. All data were collected from the electronic health record for 28-day outcomes. All UE events, including SE and other causes for UE, number and dosages of sedatives at the time of SE, adverse events, such as cardiac arrest and anoxic brain injury following UE, were examined.

RESULTS:

A total of 205 patients were included in the study. Of these, 24 patients (11.7%) had one or more UE. Nine were due to SE (4.4%). None of these patients had plans for extubation. Only one was not on sedation due to a delay on the general medicine floor. The rest were sedated on 2 or more sedatives, including continuous infusions of opioids, propofol, dexmedetomidine, and ketamine at high doses. (Table 1) Five patients out of 9 with SE got reintubated right after SE event (55.6%). Two patients with SE events did not require reintubation (22.2%). There were 2 cardiac arrests following 9 SE events (22.2%), and only 1 patient survived. The 28-day mortality for patients with SE and patients without any UE were 66.7 % and 62%, respectively.

CONCLUSIONS:

Multiple SE events occurred in ARDS in COVID-19 patients, who were on multiple sedatives without any plans for extubation trial. In comparison with SE in other ARDS patients, these patients required higher doses of sedatives to achieve adequate sedation. SE events also had a significant rate of complication. Although this study is limited by its small sample size, it provides a narrative of what the experience has been with the COVID-19 patients. This highlights the need for further studies with higher statistical power in order to better understand the disease characteristics. CLINICAL IMPLICATIONS Critical care physicians should consider tracheostomy in ARDS patients with COVID-19, to prevent complications of heavy sedation required for endotracheal intubation and complications of SE. DISCLOSURES Advisory Committee Member relationship with Ambu Please note $1-$1000 by Olumayowa Abe, source=Admin input, value=Honoraria No relevant relationships by Ahmed Al-Ghrairi, source=Web Response No relevant relationships by Ettaib El Marabti, source=Web Response No relevant relationships by Hadya Elshakh, source=Web Response No relevant relationships by Teressa Ju, source=Web Response No relevant relationships by Michael Karass, source=Admin input No relevant relationships by Miri Kim, source=Web Response No relevant relationships by Jack Mann, source=Web Response No relevant relationships by Christina Jee Ah Rhee, source=Web Response No relevant relationships by Fizza Sajid, source=Web Response No relevant relationships by Angelina Voronina, source=Web Response

Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Chest Year: 2020 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Chest Year: 2020 Document Type: Article