Sedation practices in covid-19 versus non-covid-19 acute respiratory distress syndrome patients

Introduction: Coronavirus disease 2019-associated acute respiratory distress syndrome (CARDS) has been associated with high opioid and sedative requirements in patients requiring mechanical ventilation (MV). The purpose of this study was to characterize opioid and sedative use in patients with CARDS compared to those with non-CARDS. Methods: A retrospective cohort study compared adult patients admitted to an intensive care unit (ICU) on MV with CARDS or non-CARDS between January 2018 and May 2020. Patients receiving at least one opioid or sedative infusion for at least 48 hrs were included. Patients were excluded if they were transferred from an outside hospital while on MV, deemed comfort care, admitted for status epilepticus, ischemic, or hemorrhagic stroke and/or cardiac arrest, admitted with a tracheostomy, or received extracorporeal membrane oxygenation. Statistical analysis was conducted using descriptive statistics with the appropriate statistical tests depending on the distribution type. The primary objective was to compare the use of opioid and sedative agents administered to patients with CARDS and non-CARDS. Secondary objectives included neuromuscular blocking agent (NMBA) use, time on mechanical ventilation (MV), in-hospital and ICU length of stay (LOS). Results: A total of 59 CARDS and 19 non-CARDS patients were included. Opioid infusions were used in 100% of non-CARDS patients and 98% of CARDS patients during the first 10 days of MV (p=0.57). There was significantly higher use of propofol in CARDS patients compared to non-CARDS patients (100% vs 89%, p=0.01) and higher median daily dose (3847mg vs 2992mg; p=0.018). No difference in median cumulative dose of BZD was observed in the CARDS group vs non-CARDS group (50mg vs 9mg; p=0.131). Time on mechanical ventilation was significantly longer in the CARDS group compared to the non-CARDS group (17 days vs 11 days, p=0.003). Comparably, 73% of CARDS received NMBA vs 53% in non-CARDS, p=0.05. There was significantly higher in-hospital LOS (36 days vs 48 days, p=0.005) and ICU LOS (15 days vs 31 days, p=0.002) in the CARDS group compared to the non- CARDS group. Conclusions: Patients with CARDS were more likely to receive NMBA and required higher dosages of propofol. CARDS patients were on MV longer and had longer hospital and ICU LOS.