Essential ICU drug shortages for COVID-19: what can frontline clinicians do?

Analgesia and sedation in patients with ARDS

“…Difficulties in the provision of sedatives for the critically ill have been compounded by COVID-19-related disruptions of the supply chain for traditional therapeutic options as a result of increasing demand, stockpiling, temporary lockdowns in manufacturing, and restrictions on exporting [12]. Continuously updated international websites are available to help identify and mitigate these drug shortages with prominent examples including fentanyl, propofol, midazolam, and cisatracurium.…”

“…The manuscript was written by authors grouped by section, following their own search of literature and own experience, then homogenized by coordinators (GC, JPK), and reviewed and revised by all authors. The rationale for such review is particularly relevant during the ongoing coronavirus disease 2019 (COVID- 19) pandemic due to urgent concerns about analgesic, sedative, and paralytic shortages and surging admissions that overwhelm ICU bed capacity [9][10][11][12].…”

It Takes a Village…

“…The COVID-19 pandemic resulted in international shortages of multiple critical drugs. 4 , 5 , 6 , 7 , 8 Sedatives, analgesics, and paralytics needed to support critical care were particularly affected by the surge in volumes of patients requiring mechanical ventilation, combined with high-dose requirements often used to manage severe hypoxemia. The result was a quick depletion of limited “just-in-time” inventories at many hospitals.…”

“…This situation was exacerbated by the inability to access supplies to match these new demands in either local, national, or international networks. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 There are also disparity concerns at the international level, such as preferential access and hoarding by higher income countries, and, conversely, ineffective stock management, notification systems, and demand forecasting in low- and middle-income countries. 2 , 10 , 11 , 12 Further complicating the issue are the absence of international surveillance and notification systems for medication demands and a lack of globally accepted best practices for dealing with shortages.…”

Importancia de la evaluación y terapia nutricional en pacientes críticos y no críticos con COVID-19

“…Reportes preliminares parecen indicar que en la mayoría de los casos son necesarias dosis menores que en otras poblaciones como aquellas con choque séptico 54,55 . Es importante mencionar que debido a la alta demanda de recursos se ha presentado en diversas partes del mundo una escasez de medicamentos, incluyendo norepinefrina, lo que ha llevado a la necesidad de usar de manera inicial otros vasopresores como vasopresina, epinefrina o dobutamina, los cuales pueden asociarse con mayor riesgo de isquemia digital e intestinal, hiperglucemia o acidosis láctica 56 . El impacto aislado de estos vasopresores en la tolerancia a la NE es muy limitado; por ejemplo, en el estudio NUTRIREA-2 un 80% de los participantes requirieron únicamente norepinefrina 53 , por lo cual debe tenerse especial cuidado en el monitoreo de pacientes críticos con COVID-19 con altas dosis de vasopresores y NE.…”