Effectiveness of dexmedetomidine combined with high flow nasal oxygen and long periods of awake prone positioning in moderate or severe COVID-19 pneumonia

Taboada, Manuel; Baluja, Aurora; Santos, Laura Dos; González, Isabel del Bosque; Veiras, Sonia; Caruezo, V.; Naveira, Alberto; Mirón, Paula; Nóvoa, Carmen Prado; Calvo, Andrea; Tubío, Ana; Selas, Salomé; Eiras, María; Martínez, Agustín; Campaña, Olga; Rodríguez, M. López; Diaz-Vieito, María; Cariñena, Agustín; Otero, Pablo E.; Mariño, Gumersindo; Domínguez, M. J.; Muniategui, Ignacio; Aneiros, Francisco; Álvarez, Julián

doi:10.1016/j.jclinane.2021.110261

Cited by 16 publications

(23 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Male predominance was seen in both groups as expected. In a prospective observational study in which 63 of 89 patients with severe COVID-19 were treated with DEX, HFNC and long periods of PP, mean age was 67 ± 12 and 74% of the treatment group consisted of male patients (15). These results are very similar to our study.…”

Section: Discussionsupporting

confidence: 90%

“…When we made a literature search regarding to the articles studying theurapeutic value of DEX in patients with COVID-19, we could not find any randomised controlled trials conducted with large patient populations. Except one study which we mentioned above (15), a few case reports, case series, and letters to editor constitute all studies about this issue (15) (16) (17) (18) (19) (20) (21). Among these, the study conducted by Taboada et al was the most appropriate candidate to compare our results with.…”

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

Does the Use of Dexmedetomidine Affect the Outcomes in Patients With Severe Covid-19?

İşsever

Genç

Çekiç

et al. 2021

Preprint

View full text Add to dashboard Cite

Objective: Dexmedetomidine (DEX) is a highly selective α2-adrenoceptor agonist that is increasingly used in the daily practice of intensive care units (ICUs) with its sedative, analgesic, anxiolytic, and immunoprotective effects. In this study, we aimed to analyze whether Dexmedetomidine improves the outcomes in patients treated in ICU. Design: A retrospective study Place and Duration of Study: Intensive care units (ICU) of Sakarya University Training and Research Hospital, Sakarya, Turkey, from October 2020 to February 2021 Methodology: The medical records of the patients were analyzed retrospectively. We included 134 patients in the study, in 45 of whom the treatment regimen included dexmedetomidine and 89 of whom were not treated with dexmedetomidine. Patients treated with DEX were defined as the “patient group”, whereas patients not treated with DEX were defined as “control group” and the parameters were compared between these groups. Obtained data were analyzed in the biostatistical program. Results: The median age of all patients was 64 and 62.7% of them were male. No significant difference was found between the groups in terms of median ages (p>0.05). The patients with diabetes mellitus (DM), congestive heart failure (CHF), and undergoing insulin treatment were significantly less treated with DEX (p=0.04, p=0.03, and p=0.016 respectively) whereas intravenous immunoglobulin (IVIG) therapy was found to be more frequently applied to the patient group (p=0.043). The median duration between ICU admission and the time of intubation was 4 days for the control group whereas it was 1 day for the patient group and the difference was strongly significant (p=0.000, p<0.001). The other analyses concerning lab parameters, mortality rates, intubation rates and durations, applied treatments, and comorbidities revealed no significant difference between the groups. Conclusion: Our study revealed that DEX therapy can help us to gain time before intubation however can not reduce mortality rates in severe COVID-19.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 96%

Does the Use of Dexmedetomidine Affect the Outcomes in Patients With Severe Covid-19?

İşsever

Genç

Çekiç

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…A recent study evaluated the effectiveness of dexmedetomidine combined with high flow nasal oxygen and long periods of awake prone positioning in ICU patients with moderate or severe CV19 pneumonia. 27 The study found that dexmedetomidine was satisfactory for CV19 patients with moderate or severe ARDS treated with high flow nasal cannula facilitating the acceptance of long periods of awake prone positioning. However, the study lacked a control intervention.…”

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Hemodynamic and respiratory effects of dexmedetomidine sedation in critically ill Covid‐19 patients: A retrospective cohort study

Uusalo

Valtonen

Järvisalo

2021

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Introduction Dexmedetomidine has been suggested to be a promising sedative for patients with Covid‐19 infection (CV19). However, use of dexmedetomidine is limited by its heart rate (HR) and arterial blood pressure lowering effects. Moreover, CV19 is associated with cardiac manifestations including bradyarrythmias. The hemodynamic effects of dexmedetomidine have not been previously studied in CV19 patients. We evaluated the effects of dexmedetomidine on hemodynamic and respiratory parameters of CV19 patients. Methods In this single center study, all CV19 patients receiving dexmedetomidine for sedation during a one year period were included. Our primary outcomes included changes in HR, mean arterial pressure (MAP), respiratory rate (RR), partial oxygen pressure of arterial blood/fraction of inspired oxygen‐ratio (PF‐ratio), and Richmond Agitation and Sedation Score (RASS) during dexmedetomidine administration. Results We identified 39 patients with a mean (SD) age of 58.3 (12.7) years. After initiation of dexmedetomidine, HR decreased by 16.9 (3.3) beats/min (95% CI 9.5–22.4; p < 0.001). During the 12‐hour follow‐up period, HR decrease was significant at 2 to 12 h. Incident bradycardia (<45/min) was reported in 12 (30.8%) patients and it was associated with lower plasma C‐reactive protein, Pro‐calcitonin, and troponin T levels. There was no change in MAP compared to baseline. Dexmedetomidine administration was associated with improvement of PF‐ratio ( p < 0.001) and with decrease of RASS ( p = 0.004). Conclusions Dexmedetomidine is an effective sedative for CV19 patients and may improve their oxygenation. However, dexmedetomidine administration is associated with marked decline in HR and with a high incidence of bradycardia in patients with CV19.

show abstract

“…It should be noted that only a minority of patients complied with the 16 h/day in the prone position, which is in line with the low adherence to prone reported by previous investigators [ 135 ]. Some authors have proposed dexmedetomidine as a way to increase the tolerance of prolonged prone position in awake patients with COVID-19 [ 136 ].…”

Section: Prone Position During High-flow Nasal Oxygen or Noninvasive Ventilation In Patients With Covid-19mentioning

confidence: 99%

The Role of Noninvasive Respiratory Management in Patients with Severe COVID-19 Pneumonia

Akoumianaki

Ischaki

Karagiannis

et al. 2021

JPM

View full text Add to dashboard Cite

Acute hypoxemic respiratory failure is the principal cause of hospitalization, invasive mechanical ventilation and death in severe COVID-19 infection. Nearly half of intubated patients with COVID-19 eventually die. High-Flow Nasal Oxygen (HFNO) and Noninvasive Ventilation (NIV) constitute valuable tools to avert endotracheal intubation in patients with severe COVID-19 pneumonia who do not respond to conventional oxygen treatment. Sparing Intensive Care Unit beds and reducing intubation-related complications may save lives in the pandemic era. The main drawback of HFNO and/or NIV is intubation delay. Cautious selection of patients with severe hypoxemia due to COVID-19 disease, close monitoring and appropriate employment and titration of HFNO and/or NIV can increase the rate of success and eliminate the risk of intubation delay. At the same time, all precautions to protect the healthcare personnel from viral transmission should be taken. In this review, we summarize the evidence supporting the application of HFNO and NIV in severe COVID-19 hypoxemic respiratory failure, analyse the risks associated with their use and provide a path for their proper implementation.

show abstract

Effectiveness of dexmedetomidine combined with high flow nasal oxygen and long periods of awake prone positioning in moderate or severe COVID-19 pneumonia

Cited by 16 publications

References 10 publications

Does the Use of Dexmedetomidine Affect the Outcomes in Patients With Severe Covid-19?

Does the Use of Dexmedetomidine Affect the Outcomes in Patients With Severe Covid-19?

Hemodynamic and respiratory effects of dexmedetomidine sedation in critically ill Covid‐19 patients: A retrospective cohort study

The Role of Noninvasive Respiratory Management in Patients with Severe COVID-19 Pneumonia

Contact Info

Product

Resources

About