How to Manage Withdrawal of Sedation and Analgesia in Mechanically Ventilated COVID-19 Patients?
Amédée Ego, Katarina Halenarova, Jacques Créteur, Fabio Silvio Taccone
Abstract
COVID-19 patients suffering from severe acute respiratory distress syndrome (ARDS) require mechanical ventilation (MV) for respiratory failure. To achieve these ventilatory goals, it has been observed that COVID-19 patients in particular require high regimens and prolonged use of sedatives, analgesics and neuromuscular blocking agents (NMBA). Withdrawal from analgo-sedation may induce a "drug withdrawal syndrome" (DWS), i.e., clinical symptoms of anxiety, tremor, agitation, hallucinations and vomiting, as a result of adrenergic activation and hyperalgesia. We describe the epidemiology, mechanisms leading to this syndrome and our strategies to prevent and treat it.
Topics & Concepts
MedicineSedationAnesthesiaARDSMechanical ventilationCoronavirus disease 2019 (COVID-19)AnxietyIntensive care medicineVomitingDrug withdrawalNeuromuscular Blocking AgentsRespiratory distressWithdrawal syndromeDrugLungInternal medicinePharmacologyPsychiatryInfectious disease (medical specialty)DiseaseAlcoholism and Thiamine DeficiencyIntensive Care Unit Cognitive DisordersLong-Term Effects of COVID-19