The results of a recent retrospective, single-center cohort study published in the American Journal of Health-System Pharmacy confirmed the increased sedative usage in critically-ill COVID-19 patients corresponding to sedation practices as per guidelines in other critically ill patients.

Aditi Balakrishna et al. performed this study to assess the use of sedatives in 86 critically ill, mechanically ventilated COVID-19 patients.

The routine use of sedative medicines, doses, drug combinations, and duration of administration were noted and compared to published guidelines for sedation of critically ill patients. Associations between doses, number of drugs used, baseline patient characteristics, and inflammatory markers were examined.

Initially, the combination of propofol and hydromorphone was frequently used, with these drugs being used on a given day in about 100% and 88% of patients, respectively. In the first 10 days, the doses of sedative and analgesic infusions increased, as per published dosage recommendations for propofol (48% of patients), hydromorphone (38%), ketamine (32%), dexmedetomidine (29%), and midazolam (7.7%).

By day 2, the simultaneous administration of sedative and analgesic agents augmented over time for each patient, with >50% of patients needing 3 or more drugs. This group comprised of younger patients with increased body mass index, serum ferritin, and lactate dehydrogenase concentrations, and a lower PaO₂:FIO₂ (ratio of arterial partial pressure of oxygen to fraction of inspired oxygen) and those who were expected to receive a neuromuscular block.

Thus, there is a raised sedative use in critically ill coronavirus-infected patients requiring mechanical ventilation.