Department of Pharmacy, 25047Yale-New Haven Health System, New Haven, CT, USA.
Department of Pharmacy, 2569Cleveland Clinic, Cleveland, OH, USA.
J Intensive Care Med. 2021 Feb;36(2):157-174. doi: 10.1177/0885066620951426. Epub 2020 Aug 26.
The rapid spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to a global pandemic. The 2019 coronavirus disease (COVID-19) presents with a spectrum of symptoms ranging from mild to critical illness requiring intensive care unit (ICU) admission. Acute respiratory distress syndrome is a major complication in patients with severe COVID-19 disease. Currently, there are no recognized pharmacological therapies for COVID-19. However, a large number of COVID-19 patients require respiratory support, with a high percentage requiring invasive ventilation. The rapid spread of the infection has led to a surge in the rate of hospitalizations and ICU admissions, which created a challenge to public health, research, and medical communities. The high demand for several therapies, including sedatives, analgesics, and paralytics, that are often utilized in the care of COVID-19 patients requiring mechanical ventilation, has created pressure on the supply chain resulting in shortages in these critical medications. This has led clinicians to develop conservation strategies and explore alternative therapies for sedation, analgesia, and paralysis in COVID-19 patients. Several of these alternative approaches have demonstrated acceptable levels of sedation, analgesia, and paralysis in different settings but they are not commonly used in the ICU. Additionally, they have unique pharmaceutical properties, limitations, and adverse effects. This narrative review summarizes the literature on alternative drug therapies for the management of sedation, analgesia, and paralysis in COVID-19 patients. Also, this document serves as a resource for clinicians in current and future respiratory illness pandemics in the setting of drug shortages.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的迅速传播导致了全球大流行。2019 年冠状病毒病（COVID-19）的症状范围从轻度到需要重症监护病房（ICU）入院的危急重症。急性呼吸窘迫综合征是重症 COVID-19 患者的主要并发症。目前，尚无针对 COVID-19 的公认药物治疗方法。然而，大量 COVID-19 患者需要呼吸支持，其中很大一部分需要有创通气。感染的迅速传播导致住院和 ICU 入院率激增，这对公共卫生、研究和医疗界构成了挑战。几种疗法的需求很高，包括镇静剂、镇痛药和肌松剂，这些药物通常用于需要机械通气的 COVID-19 患者的治疗，这给供应链带来了压力，导致这些关键药物短缺。这导致临床医生制定了节约策略，并探索 COVID-19 患者镇静、镇痛和麻痹的替代疗法。这些替代方法中的几种在不同环境中已证明具有可接受的镇静、镇痛和麻痹水平，但在 ICU 中并不常用。此外，它们具有独特的药物特性、局限性和不良反应。本叙述性综述总结了 COVID-19 患者镇静、镇痛和麻痹管理替代药物治疗的文献。此外，本文档还为药物短缺情况下的临床医生提供了在当前和未来呼吸道疾病流行期间的资源。
