The role of dexmedetomidine in ARDS: an approach to non-intensive care sedation
IntroductionSevere COVID-19 is a life-threatening condition characterized by complications such as interstitial pneumonia, hypoxic respiratory failure, and acute respiratory distress syndrome (ARDS). Non-pharmacological intervention with mechanical ventilation plays a key role in treating COVID-19-r...
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| Format: | Article |
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1224242/full |
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| author | Francesca Simioli Anna Annunziata Antonietta Coppola Pasquale Imitazione Angela Irene Mirizzi Antonella Marotta Rossella D’Angelo Giuseppe Fiorentino |
| author_facet | Francesca Simioli Anna Annunziata Antonietta Coppola Pasquale Imitazione Angela Irene Mirizzi Antonella Marotta Rossella D’Angelo Giuseppe Fiorentino |
| author_sort | Francesca Simioli |
| collection | DOAJ |
| description | IntroductionSevere COVID-19 is a life-threatening condition characterized by complications such as interstitial pneumonia, hypoxic respiratory failure, and acute respiratory distress syndrome (ARDS). Non-pharmacological intervention with mechanical ventilation plays a key role in treating COVID-19-related ARDS but is influenced by a high risk of failure in more severe patients. Dexmedetomidine is a new generation highly selective α2-adrenergic receptor (α2-AR) agonist that provides sedative effects with preservation of respiratory function. The aim of this study is to assess how dexmedetomidine influences gas exchange during non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) in moderate to severe ARDS caused by COVID-19 in a non-intensive care setting.MethodsThis is a single center retrospective cohort study. We included patients who showed moderate to severe respiratory distress. All included subjects had indication to NIV and were suitable for a non-intensive setting of care. A total of 170 patients were included, divided in a control group (n = 71) and a treatment group (DEX group, n = 99).ResultsA total of 170 patients were hospitalized for moderate to severe ARDS and COVID-19. The median age was 71 years, 29% females. The median Charlson comorbidity index (CCI) was 2.5. Obesity affected 21% of the study population. The median pO2/FiO2 was 82 mmHg before treatment. After treatment, the increase of pO2/FiO2 ratio was clinically and statistically significant in the DEX group compared to the controls (125 mmHg [97–152] versus 94 mmHg [75–122]; ***p < 0.0001). A significative reduction of NIV duration was observed in DEX group (10 [7–16] days vs. 13 [10–17] days; *p < 0.02). Twenty four patients required IMV in control group (n = 71) and 16 patients in DEX group (n = 99) with a reduction of endotracheal intubation of 62% (OR 0.38; **p < 0.008). A higher incidence of sinus bradycardia was observed in the DEX group.ConclusionDexmedetomidine provides a “calm and arousal” status which allows spontaneous ventilation in awake patients treated with NIV and HFNC. The adjunctive therapy with dexmedetomidine is associated with a higher pO2/FiO2, lower duration of NIV, and a lower risk of NIV failure. A higher incidence of sinus bradycardia needs to be considered. |
| first_indexed | 2024-03-12T11:39:57Z |
| format | Article |
| id | doaj.art-c8a97ca59a794fa58ddca7172ae71c35 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-03-12T11:39:57Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj.art-c8a97ca59a794fa58ddca7172ae71c352023-08-31T20:04:56ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-08-011010.3389/fmed.2023.12242421224242The role of dexmedetomidine in ARDS: an approach to non-intensive care sedationFrancesca SimioliAnna AnnunziataAntonietta CoppolaPasquale ImitazioneAngela Irene MirizziAntonella MarottaRossella D’AngeloGiuseppe FiorentinoIntroductionSevere COVID-19 is a life-threatening condition characterized by complications such as interstitial pneumonia, hypoxic respiratory failure, and acute respiratory distress syndrome (ARDS). Non-pharmacological intervention with mechanical ventilation plays a key role in treating COVID-19-related ARDS but is influenced by a high risk of failure in more severe patients. Dexmedetomidine is a new generation highly selective α2-adrenergic receptor (α2-AR) agonist that provides sedative effects with preservation of respiratory function. The aim of this study is to assess how dexmedetomidine influences gas exchange during non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) in moderate to severe ARDS caused by COVID-19 in a non-intensive care setting.MethodsThis is a single center retrospective cohort study. We included patients who showed moderate to severe respiratory distress. All included subjects had indication to NIV and were suitable for a non-intensive setting of care. A total of 170 patients were included, divided in a control group (n = 71) and a treatment group (DEX group, n = 99).ResultsA total of 170 patients were hospitalized for moderate to severe ARDS and COVID-19. The median age was 71 years, 29% females. The median Charlson comorbidity index (CCI) was 2.5. Obesity affected 21% of the study population. The median pO2/FiO2 was 82 mmHg before treatment. After treatment, the increase of pO2/FiO2 ratio was clinically and statistically significant in the DEX group compared to the controls (125 mmHg [97–152] versus 94 mmHg [75–122]; ***p < 0.0001). A significative reduction of NIV duration was observed in DEX group (10 [7–16] days vs. 13 [10–17] days; *p < 0.02). Twenty four patients required IMV in control group (n = 71) and 16 patients in DEX group (n = 99) with a reduction of endotracheal intubation of 62% (OR 0.38; **p < 0.008). A higher incidence of sinus bradycardia was observed in the DEX group.ConclusionDexmedetomidine provides a “calm and arousal” status which allows spontaneous ventilation in awake patients treated with NIV and HFNC. The adjunctive therapy with dexmedetomidine is associated with a higher pO2/FiO2, lower duration of NIV, and a lower risk of NIV failure. A higher incidence of sinus bradycardia needs to be considered.https://www.frontiersin.org/articles/10.3389/fmed.2023.1224242/fullacute respiratory distress syndromenon-invasive ventilationcontinuous positive airway pressurepressure support ventilationhigh flow nasal cannularefractory hypoxemia |
| spellingShingle | Francesca Simioli Anna Annunziata Antonietta Coppola Pasquale Imitazione Angela Irene Mirizzi Antonella Marotta Rossella D’Angelo Giuseppe Fiorentino The role of dexmedetomidine in ARDS: an approach to non-intensive care sedation Frontiers in Medicine acute respiratory distress syndrome non-invasive ventilation continuous positive airway pressure pressure support ventilation high flow nasal cannula refractory hypoxemia |
| title | The role of dexmedetomidine in ARDS: an approach to non-intensive care sedation |
| title_full | The role of dexmedetomidine in ARDS: an approach to non-intensive care sedation |
| title_fullStr | The role of dexmedetomidine in ARDS: an approach to non-intensive care sedation |
| title_full_unstemmed | The role of dexmedetomidine in ARDS: an approach to non-intensive care sedation |
| title_short | The role of dexmedetomidine in ARDS: an approach to non-intensive care sedation |
| title_sort | role of dexmedetomidine in ards an approach to non intensive care sedation |
| topic | acute respiratory distress syndrome non-invasive ventilation continuous positive airway pressure pressure support ventilation high flow nasal cannula refractory hypoxemia |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1224242/full |
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