Ego Amédée, Peluso Lorenzo, Gorham Julie, Diosdado Alberto, Restuccia Giovanni, Creteur Jacques, Taccone Fabio Silvio
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium.
Microorganisms. 2021 Nov 20;9(11):2393. doi: 10.3390/microorganisms9112393.
To assess differences in the use of analgesics, sedatives and neuromuscular-blocking agents (NMBA) in patients with acute respiratory distress syndrome (ARDS) due to COVID-19 or other conditions.
Retrospective observational cohort study, single-center tertiary Intensive Care Unit. COVID-19 patients with ARDS (March-May 2020) and non-COVID ARDS patients (2017-2020) on mechanical ventilation and receiving sedation for at least 48 h.
A total of 39 patients met the inclusion criteria in each group, with similar demographics at baseline. COVID-19 patients had a longer duration of MV (median 22 (IQRs 16-29) vs. 9 (6-18) days; < 0.01), of sedatives administration (18 (11-22) vs. 5 (4-9) days; < 0.01) and NMBA therapy (12 (9-16) vs. 3 (2-7) days; < 0.01). During the first 7 days of sedation, compared to non-COVID patients, COVID patients received more frequently a combination of multiple sedative drugs (76.9% vs. 28.2%; < 0.01) and a higher NMBA regimen (cisatracurium: 3.0 (2.1-3.7) vs. 1.3 (0.9-1.9) mg/kg/day; < 0.01).
The duration and consumption of sedatives and NMBA was significantly increased in patients with COVID-19 related ARDS than in non-COVID ARDS. Different sedation strategies and protocols might be needed in COVID-19 patients with ARDS, with potential implications on long-term complications and drugs availability.
评估因新型冠状病毒肺炎（COVID-19）或其他病症导致的急性呼吸窘迫综合征（ARDS）患者在使用镇痛药、镇静剂和神经肌肉阻滞剂（NMBA）方面的差异。
回顾性观察队列研究，单中心三级重症监护病房。对2020年3月至5月患有ARDS的COVID-19患者以及2017年至2020年接受机械通气并接受至少48小时镇静的非COVID-19 ARDS患者进行研究。
每组共有39例患者符合纳入标准，基线时人口统计学特征相似。COVID-19患者机械通气时间更长（中位数22（四分位间距16 - 29）天对9（6 - 18）天；<0.01），镇静剂使用时间更长（18（11 - 22）天对5（4 - 9）天；<0.01），NMBA治疗时间更长（12（9 - 16）天对3（2 - 7）天；<0.01）。在镇静的前7天，与非COVID-19患者相比，COVID-19患者更频繁地接受多种镇静药物联合使用（76.9%对28.2%；<0.01），且NMBA使用方案剂量更高（顺式阿曲库铵：3.0（2.1 - 3.7）毫克/千克/天对1.3（0.9 - 1.9）毫克/千克/天；<0.01）。
与非COVID-19 ARDS患者相比，COVID-19相关ARDS患者的镇静剂和NMBA使用时间及消耗量显著增加。对于患有ARDS的COVID-19患者可能需要不同 的镇静策略和方案，这对长期并发症和药物供应可能有潜在影响。
