OBJECTIVE: To demonstrate the effective role of Dexmedetomidine as a sedative and analgesic agent in Covid-19 patients when used in conjunction with the established treatment of Acute Respiratory Distress Syndrome.
INTRODUCTION: Covid-19 disease is a deadly contagious disease with milder symptoms to a more severe form with acute respiratory failure, septic shock leading to even death. Literature study shows High Flow Nasal Oxygen therapy and prolonged prone position sessions to be beneficial in the treatment of ARDS, however, to facilitate those sessions, a sedative and anxiolytic agent must be added in the treatment. Therefore, this study was conducted to document the beneficial role of dexmedetomidine as a sedative agent.
METHODOLOGY: Retrospective observational study which included 150 PCR positive patients admitted in Covid ITC, from 1st February 2021 to 31st July 2021 residing in the premises of PAF Air Base, Mushaf, Sargodha. Data was analyzed using SPSS software.
RESULTS: Out of 150 patients, 120 (80%) were treated with High Flow Nasal Oxygen (HFNO), Dexmedetomidine infusion (DEXME) and long periods of prone position (PP) sessions. Among these 120 patients, 88 (73.3%) were discharged while 32 (26.67%) patients died of which 7 (21.875%) died while being on HFNO therapy and 25 (78.125%) patients were intubated. DEXME infusion was found to have a positive outcome (P-value <0.005) in the treatment of moderate to severe ARDS.
CONCLUSION: Our findings suggest that DEXME infusion is beneficial in moderate to severe ARDS caused by SARS-CoV2 when given along with HFNO therapy and prolonged PP sessions, thereby, avoiding intubation.
Callaway E, Cyranoski D, Mallapaty S, Stoye E, Tollefson J. The coronavirus pandemic in five powerful charts. Nature. 2020;579:482–483. [PubMed] [Google Scholar]
Yang R, Xu Y, Gong P. Clinical characteristics of 36 non-survivors with COVID-19 in Wuhan, China. medRxiv. 2020; doi: 10.1101/2020.02.27.20029009
Song C-Y, Xu J, He J-Q, Lu Y-Q. COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients. medRxiv. 2020; doi: 10.1101/2020.03.05.20031906
S, Chong J.H, Sankaranarayanan V, Harky A. COVID-19 and multiorgan response. Curr Probl Cardiol. 2020;45:100618. [PMC free article] [PubMed] [Google Scholar]
Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020 Oct 1;180(10):1345–1355. doi: 10.1001/jamainternmed.2020.3539. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
X, Zhang B, Li P, et al. Incidence, clinical characteristics and prognostic factor of patients with COVID-19: a systematic review and meta-analysis. medRxiv. 2020; doi: 10.1101/2020.03.17.20037572
Frat J.P, Thille A.W, Mercat A, Girault C, Ragot S, Perbet S. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015 Jun 4;372(23):2185–2196. doi: 10.1056/NEJMoa1503326. [PubMed] [CrossRef] [Google Scholar]
Guérin C, Reignier J, Richard J.C, Beuret P, Gacouin A, Boulain T. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013 Jun 6;368(23):2159–2168. doi: 10.1056/NEJMoa1214103. [Epub 2013 May 20][PubMed] [CrossRef] [Google Scholar]
Taboada M, González M, Álvarez A, González I, García J, Eiras M. Effectiveness of prone positioning in nonintubated intensive care unit patients with moderate to severe acute respiratory distress syndrome by coronavirus disease 2019. Anesth Analg. 2021 Jan;132(1):25–30. doi: 10.1213/ANE.0000000000005239. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Artigas R, Ferreyro B.L, Angriman F, Hernández-Sanz M, Arruti E, Torres A. High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure. Crit Care. 2021 Feb 11;25(1):58. doi: 10.1186/s13054-02103469-w. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Raoof S, Nava S, Carpati C, Hill N.S. High-flow, noninvasive ventilation and awake (nonintubation) proning in patients with coronavirus disease 2019 with respiratory failure. Chest. 2020 Nov;158(5):1992–2002.doi: 10.1016/j.chest.2020.07.013. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Xu Q, Wang T, Qin X, Jie Y, Zha L, Lu W. Early awake prone position combined with high-flow nasal oxygen therapy in severe COVID-19: a case series. Crit Care. 2020 May 24;24(1):250. doi: 10.1186/s13054-020-02991-7. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Zhao H, Davies R, Ma D. Potential therapeutic value of dexmedetomidine in COVID-19 patients admitted to ICU. Br J Anaesth. 2021;126:33–35. doi: 10.1016/j.bja.2020.09.031. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Jain A, Lamperti M, Doyle D.J. Dexmedetomidine: another arrow in the quiver to fight COVID-19 in intensive care units. Br J Anaesth. 2021 Jan;126(1):e35–e38. doi: 10.1016/j.bja.2020.10.010. [Epub 2020 Oct 14] [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Wang K, Wu M, Xu J. Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis. Br J Anaesth. 2019;123:777–794. [PubMed] [Google Scholar]
Sun Y-B, Zhao H, Mu D-L. Dexmedetomidine inhibits astrocyte pyroptosis and subsequently protects the brain in in vitro and in vivo models of sepsis. Cell Death Dis. 2019;10:167. [PMC free article] [PubMed] [Google Scholar]
Gu J, Sun P, Zhao H. Dexmedetomidine provides renoprotection against ischemia-reperfusion injury in mice. Crit Care. 2011;15:R153. [PMC free article] [PubMed] [Google Scholar]
Ma J, Chen Q, Li J. Dexmedetomidine-mediated prevention of renal ischemia-reperfusion injury depends in part on cholinergic anti-inflammatory mechanisms. Anesth Analg. 2020;130:1054–1062. [PubMed] [Google Scholar]
Petrilli CM, Jones SA, Yang J, Rajagopalan H, O’Donnell LF, Chernyak Y, et al. Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 disease in New York City. MedRxiv. 2020;Preprint.