Background Patients with COVID-19 acute respiratory distress syndrome (ARDS) have been shown to have high sedation requirements. Objective The purpose of this study was to compare sedative use between patients with COVID-19 ARDS and non-COVID-19 ARDS. Methods This was a retrospective study of patients with COVID-19 ARDS compared with historical controls of non-COVID-19 ARDS who were admitted to 2 hospitals from March 1, 2020, to April 30, 2020, and April 1, 2018, to December 31, 2019, respectively. The primary outcome was median cumulative dose of propofol (µg/kg) at 24 hours after intubation. Results There were 92 patients with COVID-19 ARDS and 37 patients with non-COVID-19 ARDS included. Within the first 24 hours of intubation, patients with COVID-19 ARDS required higher total median doses of propofol: 51 045 µg/kg (interquartile range, 26 150-62 365 µg/kg) versus 33 350 µg/kg (9632-51 455 µg/kg; P = 0.004). COVID-19 patients were more likely receive intravenous lorazepam (37% vs 14%; P = 0.02) and higher cumulative median doses of midazolam by days 5 (14 vs 4 mg; P = 0.04) and 7 of intubation (89 vs 4 mg; P = 0.03) to achieve the same median Richmond Analgesia-Sedation Scale scores. COVID-19 ARDS patients required more ventilator days (10 vs 6 days; P = 0.02). There was no difference in 30-day mortality. Conclusion and Relevance Patients with COVID-19 ARDS required higher doses of propofol and benzodiazepines than patients with non-COVID-19 ARDS to achieve the same median levels of sedation.

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Ultrasound has become an essential skill for trauma management in resource-limited areas. Prohibitive costs of commercial ultrasound phantoms limit the abilities of many hospitals to adequately train health-care providers. We assessed the utility of homemade phantoms in a wartime setting. Thirty physicians and technicians enrolled in a medical training course, sponsored by the Syrian American Medical Society (SAMS). Ultrasound simulation models were created onsite by using psyllium, gelatin, a hotel coffee maker, and Pyrex dishes. Lamb hearts were used to teach visual diagnosis and subsequent drainage of pericardial effusions. Penrose drains were used to teach vein identification and cannulation under dynamic ultrasound guidance. Two phantoms with a total of 14 penrose drains were created, serving 30 health-care providers. Feedback from participants was positive and within one month of the course, two cases of pericardial tamponade were diagnosed and surgically treated in the largest trauma hospital operated by SAMS. Context : In resource-limited environments, ultrasound phantoms (models) are cost-prohibitive. Aims : We assessed the utility of homemade phantoms in a resource-limited wartime setting to train Syrian physicians and technicians in vein cannulation and limited cardiac ultrasonography. Settings and Design : Thirty physicians and technicians enrolled in a medical training course, sponsored by SAMS. Methods : Ultrasound simulation models were created onsite by using psyllium, gelatin, a hotel coffee maker, and Pyrex dishes. Lamb hearts were used to teach visual diagnosis and subsequent drainage of pericardial effusions. Penrose drains were used to teach vein identification and cannulation under dynamic ultrasound guidance. Two phantoms with a total of 14 penrose drains were created, serving 30 health-care providers. Statistical Analysis Used : N/A Results : Feedback from participants was positive and within one month of the course, two cases of pericardial tamponade were diagnosed and surgically treated in the largest trauma hospital operated by SAMS. Conclusions : Homemade ultrasound phantoms are a promising cost-effective means for meeting an educational gap in ultrasound training, particularly for resource-limited hospitals and possibly more broadly in residency education.