by Lauren J. Andrews and Scott T. Benken
Critical Care volume 24,
Article number: 375 (2020)
Letter:
The recent article by Kotfis and colleagues provides great
insight regarding newly identified COVID-related risk factors contributing to
ICU delirium, while also presenting valid potential solutions to barriers
surrounding the implementation of the ABCDEF safety bundle for ICU liberation [1]. However, we feel that the omission of
pertinent medication availability and selection limitations currently
afflicting healthcare teams around the world warrants further discussion.
In the setting of medication shortages and anecdotally high
sedation requirements in COVID patients, it has become increasingly necessary
to utilize various combinations of second-line and adjunct therapy options in
order to maintain appropriate levels of sedation, with indications for
neuromuscular blockade and prone positioning further exacerbating this need [1]. Keeping the known sedation limitations
of dexmedetomidine in mind [2], clinicians may be more inclined to use
benzodiazepine infusions if unable to obtain adequate supplies of common
first-line agents (e.g., fentanyl, propofol). Despite the well-documented
association between benzodiazepines and delirium, this approach may be
unavoidable for a large number of institutions. Ketamine may be a possible
solution, however, as more data has recently emerged regarding its safety and
efficacy as an adjunct therapy for analgosedation [3]….
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