Sedative medications in COVID-19 positive ARDS patients undergoing tracheostomy

Abstract

Intro: Patients intubated with COVID-19 ARDS have required significant amounts of sedation and analgesic medications (SAM). This can lead to longer length of hospital/ICU stay, days of delirium, and has been associated with mortality. We aimed to evaluate SAM administration in patients undergoing tracheostomy resultant from COVID-19 ARDS.

Methods: A retrospective registry of all patients with COVID-19 ARDS who had a consult for tracheostomy placement at the Johns Hopkins Hospital during the months of 03/2020 - 08/2020. Data were collected by retrospective chart review and EPIC database query. In the 48 hours pre and post-tracheostomy, we collected SAM dosages, sedation parameters including GCS, RASS, and physical therapy assessment in the form of Hopkins Level of Mobility (HLM) were collected.

Results: 55 patients were enrolled with a mean age of 60.2, mean BMI of 30.2 kg/m2, 28 (51%) were male, and 39 (70.9%) of the tracheostomies were placed percutaneously. Fentanyl was used in 38 (69.1%), dexmedetomidine in 28 (50.9%), midazolam in 13 (23.6%), hydromorphone in 13 (23.6%), and propofol in 12 (21.8%) patients.

- Total fentanyl dose (6940.3 mcg to 5382.2 mcg p=0.02) and total propofol dose (67066 mcg/kg to 24098 mcg/kg, p=0.02) were significantly lower post-tracheostomy (POST) compared to pre-tracheostomy (PRE).

- Mean GCS values (8.4 to 9.1, p=0.007), mean RASS values (-1.44 to -1.16, p=0.039), mean HLM values (1.57 to 1.83, p=0.0001) all significantly improved.

Conclusions: In a small cohort of 55 COVID-19 ARDS patients, we were able to describe significantly decreased SAM administritation, improved sedation parameters, and improved physical functioning.