Abstract
Objective: The pharmacokinetics and pharmacodynamics of ECMO-supported sedative, analgesic, and muscle relaxants have changed, but there are insufficient data to determine the optimal dosing strategies for these agents. Sedation, analgesia and muscle relaxation therapy for patients with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) receiving ECMO support are more specific and have not been fully reported. This study observed and evaluated the use of sedative and analgesic drugs and muscle relaxants in SARS-CoV-2 patients treated with VV-ECMO.Methods: This study was a single-center, retrospective and observational study. Our study includes 8 SARS-CoV-2 patients treated with VV-ECMO in an intensive care unit at Shanghai Public Health Center from February to June 2020. We collected the demographic data from these patients and the dose and course of sedation, analgesia, and muscle relaxants administered during ECMO treatment.Results: The doses of sedative, analgesic and muscle relaxant drugs used in patients with VV-ECMO were significant. Over time, the doses of drugs that were used were increased, and the course of muscle relaxant treatment was extended.Conclusion: Sedation, analgesia, and muscle relaxant use require individualized titration in patients with SARS-CoV-2 who have respiratory failure and who are receiving VV-ECMO.
Highlights
Extracorporeal membrane oxygenation (ECMO) is an important technique for the rescue of critically ill patients, and it is used as an adjunct therapy for critically ill patients with heart failure and/or severe respiratory failure
We collected the demographic data from these patients and the dose and course of sedation, analgesia, and muscle relaxants administered during ECMO treatment
The doses of sedative, analgesic and muscle relaxant drugs used in patients with VV-ECMO were significant
Summary
Extracorporeal membrane oxygenation (ECMO) is an important technique for the rescue of critically ill patients, and it is used as an adjunct therapy for critically ill patients with heart failure and/or severe respiratory failure. If the sedation and analgesia are too shallow, it will lead to patient agitation, man-machine confrontation, pipeline dropping, an imbalance of the oxygen supply and demand, an unstable ECMO flow, and other serious consequences and can even increase the risk of infection with the novel coronavirus in the doctors and nurses It has been reported in the literature that a reasonable sedation and analgesia strategy can reduce the asynchrony between patients and ventilators and prevent man-machine confrontation [3]; it can reduce the oxygen consumption by reducing spontaneous muscle activity [4]. Current ICU analgesia/sedation guidelines first advocate the assurance of adequate analgesia, minimizing sedation, preventing patient awakening, preventing delirium, and early recovery to facilitate ventilator weaning and early ICU weaning These strategies are not always applicable to patients with ARDS who sometimes require deep sedation. Patients with severe ARDS are underrepresented in analgesic and sedative studies, and the currently recommended strategy may not be feasible [5]
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