Dexmedetomidine for sedation and correction of psychoemotional disorders in critically ill patients with COVID-19

Introduction. Most patients with COVID-19 require respiratory support and or mechanical ventilation, long-term use of high doses of sedatives, most of which should be considered in the context of the unique pathophysiology of COVID-19 and associated psychological and neurological disorders. Objective. The objective of this study was to evaluate sedation therapy effectiveness in critically ill patients with severe COVID-19 who received dexmedetomidine compared to propofol. Methods. The research was done in a prospective single center to a cohort study of critically ill 333 adult patients with COVID-19 and psychoemotional disorders (depression, anxiety and posttraumatic stress disorder) admitted in the ICU of the Republican Specialized Hospital for COVID-19 in Uzbekistan. Patients were non-invasive ventilated more than 24 hours and received intravenous sedation with dexmedetomidine or propofol. Results. The risk of progression of the pathological process decreased from 47.6% to 21.8% and, accordingly, the proportion of patients with stabilization and improvement of their condition increased from 52.4% to 79.4% (p<0.001). The possibilities of non-invasive respiratory support were expanded with a reduction in the frequency of tracheal intubations from 17.3% to 7.3% (p<0.001), the duration of ICU stay was from 12.60.8 to 9.40.6 days, and the duration of respiratory therapy was from 8.40.5 to 5.20.4 days. In particular, there was an improvement in oxygen saturation (SpO 2 ) recovery after one day of intensive therapy from 86.60.2% to 92.20.3% with noninvasive ventilation and a higher oxygenation index (2.3 in the dexmedetomidine group versus 1.6 in the propofol group, p=0.032) during the period of sedation withdrawal. Conclusion. In the presence of severe psychoemotional disorders, the effectiveness of etiotropic and pathogenetic treatment protocols of COVID-19 directly depends on the proper sedation regimen. In this aspect, dexmedetomidine provides adequate and safe respiratory support with an improvement in external respiration, blood gas composition and a minimal negative hemodynamic effect.

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