Analgesia and sedation in patients with ARDS

COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment – A narrative review

“…In patients with ARDS, analgesia and sedation should be titrated to individual patient needs, optimally allowing for lung protective ventilation, comfort, safety, and patient interaction with staff/relatives [ 122 ]. If possible, sedation should be achieved by adequate analgesia in combination with a short-acting sedative (e.g., propofol and dexmedetomidine) [ 122 ]. Furthermore, it is recommended that sedation level be re-assessed frequently and optimized when required [ 122 ].…”

“…If possible, sedation should be achieved by adequate analgesia in combination with a short-acting sedative (e.g., propofol and dexmedetomidine) [ 122 ]. Furthermore, it is recommended that sedation level be re-assessed frequently and optimized when required [ 122 ]. Generally, sedo-analgesia should be minimized in critically ill patients with ARDS and, whenever possible, with at least daily sedation holds performed [ 123 , 124 ].…”

“…Generally, sedo-analgesia should be minimized in critically ill patients with ARDS and, whenever possible, with at least daily sedation holds performed [ 123 , 124 ]. Deep sedation and analgesia should be reserved for patients with severely impaired lung function/respiratory mechanics or severe shock [ 122 ]. In patients with CARDS, there was a tendency to use deep sedation in addition to a more benzodiazepine-based sedative regime [ 122 ].…”

“…Deep sedation and analgesia should be reserved for patients with severely impaired lung function/respiratory mechanics or severe shock [ 122 ]. In patients with CARDS, there was a tendency to use deep sedation in addition to a more benzodiazepine-based sedative regime [ 122 ]. Reasons for the latter were shortages of other drugs (e.g., propofol), severely impaired lung mechanics, fear of self-extubation (particularly during proning), and the protection of health workers from accidental extubation [ 125 , 126 ].…”

“…Reasons for the latter were shortages of other drugs (e.g., propofol), severely impaired lung mechanics, fear of self-extubation (particularly during proning), and the protection of health workers from accidental extubation [ 125 , 126 ]. However, there is currently no evidence that patients with CARDS require deeper levels of sedation than patients with other types of ARDS would require [ 122 ].…”