Adams Christopher D, Altshuler Jerry, Barlow Brooke L, Dixit Deepali, Droege Christopher A, Effendi Muhammad K, Heavner Mojdeh S, Johnston Jackie P, Kiskaddon Amy L, Lemieux Diana G, Lemieux Steven M, Littlefield Audrey J, Owusu Kent A, Rouse Ginger E, Thompson Bastin Melissa L, Berger Karen
Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Piscataway, New Jersey, USA.
Department of Pharmacy, Hackensack Meridian JFK Medical Center, Edison, New Jersey, USA.
Pharmacotherapy. 2020 Dec;40(12):1180-1191. doi: 10.1002/phar.2471. Epub 2020 Nov 20.
Evidence-based management of analgesia and sedation in COVID-19-associated acute respiratory distress syndrome remains limited. Non-guideline recommended analgesic and sedative medication regimens and deeper sedation targets have been employed for patients with COVID-19 due to exaggerated analgesia and sedation requirements with extended durations of mechanical ventilation. This, coupled with a desire to minimize nurse entry into COVID-19 patient rooms, marked obesity, altered end-organ function, and evolving medication shortages, presents numerous short- and long-term challenges. Alternative analgesic and sedative agents and regimens may pose safety risks and require judicious bedside management for appropriate use. The purpose of this commentary is to provide considerations and solutions for designing safe and effective analgesia and sedation strategies for adult patients with considerable ventilator dyssynchrony and sedation requirements, such as COVID-19.
新型冠状病毒肺炎（COVID-19）相关急性呼吸窘迫综合征中基于证据的镇痛和镇静管理仍然有限。由于机械通气时间延长导致镇痛和镇静需求增加，对于COVID-19患者，采用了非指南推荐的镇痛和镇静药物方案以及更深的镇静目标。再加上尽量减少护士进入COVID-19患者病房的愿望、明显肥胖、终末器官功能改变以及不断演变的药物短缺，带来了众多短期和长期挑战。替代镇痛和镇静药物及方案可能存在安全风险，需要在床边进行明智管理以确保正确使用。本评论的目的是为患有严重呼吸机不同步和镇静需求的成年患者（如COVID-19患者）设计安全有效的镇痛和镇静策略提供考虑因素和解决方案。
