The effectiveness of dexmedetomidine in patients with severe COVID-19

Abstract

Rationale: Mortality in patients with severe COVID-19 remains high. Finding therapies that can improve the outcome in these patients is an urgent function.
 Objective: To evaluate the clinical efficacy of dexmedetomidine in the results of complex treatment with a severe course of COVID-19.
 Materials and Methods: The retrospective study included 50 adult patients with severe COVID-19 admitted to the intensive care unit (ICU). The primary outcome of the study was the incidence of delirium. The secondary results of the study were dynamics of gas exchange indicators (PaO2 and PaCO2) and inflammatory markers (C-reactive protein (CRP), procalcitonin, lymphocyte count and neutrophil-lymphocyte ratio (NLR)) for 3 and 5 days of treatment, as well as the duration of mechanical ventilation (MV), length of stay (LOS) in the ICU and hospital and mortality.
 Results: The incidence of delirium did not differ between the dexmedetomidine group and the control group (41% and 48%, respectively; p = 0,661). The LOS in the ICU and the hospital, as well as the duration of MV, was comparable between the groups. However, hospital mortality in the dexmedetomidine treatment group was lower than in the control group (10,3% and 42,9%, respectively; p = 0,008).
 The addition of dexmedetomidine to the complex of therapy did not affect the change in blood gas, but contributed to an increase in the number of lymphocytes (p = 0,006) and a decrease in NLS (p = 0,002) by the fifth day of treatment. At the same time, no significant changes in CRP and procalcitonin levels were observed.
 Conclusion: Therapy with dexmedetomidine was not accompanied by a decrease in the frequency of delirium, LOS in the ICU and the hospital, and the duration of MV in patients with severe COVID-19. Prospective randomized trials are needed to confirm the beneficial effects of dexmedetomidine on the immune system and mortality.

Association between Dexmedetomidine Use and Mortality in Patients with COVID-19 Receiving Invasive Mechanical Ventilation: A U.S. National COVID Cohort Collaborative (N3C) Study

“…Our findings are consistent with other observational studies that found lower mortality with DEX use in critically ill patients with COVID-19 [ 28 , 29 ]. The lower 28-day mortality rate with earlier DEX use relative to IMV is consistent with our previous investigation at Rush University System for Health (RUSH) hospitals [ 28 ].…”

“…DEX is reported to improve COVID-19 outcomes including improved oxygen saturation (SpO 2 ) [ 25 ], improved partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO 2 /FiO 2 ) [ 26 ], shortened duration of mechanical ventilation [ 27 ], and reduced mortality [ 28 , 29 ]. However, these investigations have been limited in both scope and size.…”