What is the Second Sedative Agent to Add to Dexmedetomidine for Sedation of COVID-19 Patients?
At present, there are no studies that evaluate the efficacy or safety of dexmedetomidine with another sedative agent among coronavirus disease 2019 (COVID-19) patients. Possible adverse events should be carefully considered in the choice of an add-on sedative agent.
• Adequate sedation is important among ventilated COVID-19 patients. Dexmedetomidine is an alpha2-adrenergic receptor agonist that produces sedation, analgesia and anxiolysis. It preserves respiratory function even when given in high doses; thus, it is commonly used for COVID-19 patients.
• Due to the high cost of dexmedetomidine, a common clinical practice is to use dexmedetomidine in combination with other sedatives.
• Co-administration of dexmedetomidine with other sedatives has an additive effect. Possible adverse effects of combination treatment include hypotension, bradycardia, and delirium.
• There are no completed or ongoing clinical trials that evaluate the efficacy or safety of dexmedetomidine with another sedative agent among COVID-19 patients.
• Currently, there are no guidelines that specifically mention the recommended add-on sedative agent to dexmedetomidine for sedation of COVID-19 patients.
• The World Health Organization recommends light sedation and minimizing continuous or intermittent sedation among suspected COVID-19 patients with severe acute respiratory infection.
• Consensus statements for mechanically ventilated COVID-19 patients recommend using dexmedetomidine, lidocaine or opioids during extubation to minimize coughing.
• Clinical practice guidelines for sedation among critically ill, mechanically ventilated adult patients recommend the use of propofol or dexmedetomidine over benzodiazepines due to decreased time to extubation, duration of stay in the intensive care unit, and incidence of delirium.