My anesthesia practice previously did not perform critical care management. Ventilated COVID patients are requiring large doses of sedation here to tolerate prone positioning, avoid ventilator dys-synchrony, avoid recall under muscle relaxant (when used). We have been asked to comment on ICU sedation options. One question we’ve seen: sedation options if medication inventories likely become insufficient. Are there any resources on suggestions particular sedation challenges of ventilated COVID patients? Thank you
We have been initiating scheduled Ativan and oxycodone per GI route scheduled to limit use of fentanyl and propofol d/t shortages. Ketamine and precedex are being used as well.
We have been using paralytics early. Sedation is via midazolam, dexmedetomidine, and ketamine. Narcotics are given by PO route unless the patient does not tolerate anything PO. Propofol is reserved for those “difficult to sedate”.
Thanks for posts, that helps,. Patients have ended up on high dose sedation of multiple sedative infusions, even with paralytics seem to require high doses just for sedation. Propofol at 150mcgm/min which proves tough to titrate down despite adding versed infusions, fentanyl infusions sometimes also precedex. Really? Is everyone using this much sedation? We (and everyone) going to run short of everything soon anyway.
Our standard at the moment is dilaudid with propofol. Titrate propofol based of triglycerides, arbitrary cut off of 500 when we decide to switch from propofol/add in another medication. Precedex has been an additive that we are using along with low dose midazolam drips of 1-2mg/hr. In case the adult has been on LONG duration (arbitrarily say 7days) and is having sedation issues class switch to fentanyl.
We have been using seroquel as well to help with the sedation. If all else fails then rocuronium intermittent for a while (cisatra is on a shortage) and if that fails/needs a lot of prn in an hour low dose roc drip.
All above (minus the roc drip we have been adding in ketamine)