Dexmedetomidine as Conduit for Non-Invasive Ventilation (NIV) Compliance in COVID-19 and Chronic Obstructive Pulmonary Disease (COPD) Patients in Intensive Care Unit (ICU) Setting: Case Series.

Abstract

Non-compliance to the non-invasive ventilation (NIV) mask in a distressed hypoxemic patient is not an unusual finding, especially in desaturated coronavirus disease(COVID-19)or chronic obstructive pulmonary disease(COPD)patients with respiratory distresswho require ventilatory support to improve oxygenation. Failure to achieve success with the non-invasive ventilatory support with the tight-fitting mask led to emergent endotracheal intubation. This was inview to avert consequences such as severe hypoxemia and subsequent cardiac arrest. Sedation is an important component of ICU management for noninvasive mechanical ventilation to improve NIV compliance/tolerance.Including the various sedatives used, such as fentanyl, propofol, or midazolam, the most suitable agentto be used asa primary/solesedative still remains unclear.Dexmedetomidineprovidinganalgosedationwithout significant respiratory depression facilitates better tolerance of NIV mask application. This case series is a retrospective analysis of patients in whom dexmedetomidine bolus followed by infusion was observed to facilitate compliance to NIV with the tight-fitting mask.Herein, a case summary of six patients with acute respiratory distresswho weredyspnoic, agitated havesevere hypoxemia were put on NIV with dexmedetomidine infusion is being reported. They were extremely uncooperative as their RASS score (Richmond Agitation-Sedation score) was + 1 to +3, not allowing the application of the NIV mask. Due to their poor compliance with to use of the NIV mask,proper ventilation could not be achieved. Dexmedetomidine infusion (0.3 to0.4mcg/kg/hr) was used after a bolus dose (0.2-0.3 mcg/kg).The RASS Score of our patients was +2 or +3 before this intervention which became -1 or -2 after including dexmedetomidine in the treatment protocol.The low dose dexmedetomidine bolus and infusion thereafter showed to improvethepatient'sacceptance of the device. Oxygen therapy with this was shown to improve patient oxygenation by allowing the acceptance of the tight-fitting NIV face mask.In conclusion, this case series serves as evidence of the use of dexmedetomidine as an effectivetherapy to calm the agitated desaturatedpatient, thereby facilitating non-invasive ventilation in COVID-19 and COPD patients and promoting better oxygenation. This may, in turn, avoid endotracheal intubation for invasive ventilation and the associated complications.