The following is a summary of “Usefulness of Inhaled Sedation in Patients With Severe ARDS Due to COVID-19,” published in the March 2023 issue of Respiratory Care by Duque et al. 

The administration of sedatives in the intensive care unit is crucial to enhancing clinical outcomes. For a prolonged period, the global community has been grappling with elevated levels of opioid utilization. To counteract the mounting opioid dependence, strategies have been instituted at both the domestic and international levels. The COVID-19 pandemic presented a formidable obstacle for healthcare systems. It resulted in a notable rise in the utilization of sedatives and opioid analgesics for extended durations and substantial quantities among many patients. Within researchers’ medical facilities, the insufficiency of various intravenous (IV) analgosedation medications necessitates the exploration of alternative options to substitute for depleted drugs or to achieve sedation objectives that prove challenging to attain with conventional medications administered at elevated dosages.

This study was a retrospective cohort analysis that examined the outcomes of individuals who met the inclusion criteria from admission to the intensive care unit until their discharge, regardless of whether they survived. Five endpoints were assessed, including the requirement for high-dose opioids (≥ 200 µg/h), the comparison of inhaled versus intravenous sedation of opioid analgesic doses, midazolam dosage, the necessity for muscle relaxant, and the potential for delirium. The study comprised 283 participants, out of which 230 received intravenous sedation while 53 were subjected to inhaled sedation. The group that received inhaled sedation exhibited relative risks (RRs) of 0.5 (95% CI 0.4–0.8, P = .045) for requiring high-dose fentanyl, 0.3 (95% CI 0.20–0.45, P < .001) for requiring muscle relaxant, and 0.8 (95% CI 0.61–1.15, P = .25) for the likelihood of experiencing delirium.

The observed median disparity in fentanyl dosage between the inhaled and IV sedation cohorts was 61 µg/h or 1,200 µg/d (equivalent to 2.2 ampules/d, P < .001). Additionally, the median difference in midazolam dosage was 5.7 mg/h. The utilization of inhaled sedation was linked with decreased dosages of opioids, benzodiazepines, and muscle relaxants in contrast to intravenous sedation. In cases where intravenous sedation is not feasible, and critically ill patients require extended ventilatory support; this therapy may be considered an alternative. The ICU staff must provide adequate supervision at all times.

Source: rc.rcjournal.com/content/68/3/293