Effectiveness of dexmedetomidine combined with high flow nasal oxygen and long periods of awake prone positioning in moderate or severe COVID-19 pneumonia

• Published in: Journal of clinical anesthesia 2021-09, Vol.72, p.110261-110261, Article 110261
• Main Authors: Taboada, Manuel, Baluja, Aurora, Santos, Laura Dos, González, Irene, Veiras, Sonia, Caruezo, Valentín, Naveira, Alberto, Mirón, Paula, Novoa, Carmen, Doldán, Patricia, Calvo, Andrea, Tubio, Ana, Selas, Salomé, Eiras, María, Martínez, Adrián, Campaña, Olga, Rodríguez, María Teresa, Diaz-Vieito, María, Cariñena, Agustín, Otero, Pablo, Mariño, Gumersindo, Domínguez, María, Muniategui, Ignacio, Aneiros, Francisco, Alvarez, Julián
• Format: Article
• Language: English
• Subjects: acute respiratory distress syndrome (ARDS); Aged; Aged, 80 and over; Anesthesia; Anticoagulants; Coronaviruses; Correspondence; COVID-19; COVID-19 - therapy; Dexmedetomidine; Dexmedetomidine - administration & dosage; High flow nasal oxygen (HFNC); Hospitals; Humans; Hypnotics and Sedatives - administration & dosage; Intensive care; Intubation; Laboratories; Male; Middle Aged; Oxygen - administration & dosage; Oxygen Inhalation Therapy - methods; Oxygen saturation; Pandemics; Patient positioning; Patient Positioning - methods; Pneumonia; Prone Position; Prone positioning (PP); SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Ventilators; Wakefulness
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2021.110261

[...]this sedative properties of DEX can help awake patients with ARDS stay in PP for long periods of time. [...]recent studies suggest DEX may enhance hypoxic pulmonary vasoconstriction, improve ventilation/perfusion ratio, and consequently improve oxygenation [8–10]. [...]these preliminary results are shared in an effort to inform other clinicians the possibility of the use a combination of DEX, HFNO and long periods of PP to treat patients with moderate or severe ARDS by COVID-19, trying to improve oxygenation and avoiding intubation and mechanical ventilation.Prior presentations No.Summary statement In this prospective observational study including sixty-three non-intubated patients admitted to the ICU with moderate or severe ARDS by COVID-19, we showed that dexmedetomidine may be useful in combination with HFNO facilitating the acceptance of long periods of awake PP.Funding statement No funding provided.Support Support was provided solely from institutional and departmental sources.Authors contributions Conception of the study: Characteristics Demographics Long PP and HFNO treatment No = 63 Long PP and HFNO Success No = 43 (68.3%) Long PP and HFNO Failure No = 20 (31.7%) P value Age, y, mean (SD) 67 ± 12 67 ± 11 66 ± 13 1 Weight, Kg, mean (SD) 84 ± 15 83 ± 14 86 ± 15 0.92 Male sex, No. (%) 47 34 (72.3%) 13 (27.7%) 0.83 BMI, Kg/m2, mean (SD) 30 ± 5.1 30 ± 4.9 32 ± 5.3 0.55 Coexisting conditions, No. (%) Hypertension 30 (48%) 22 (51%) 8 (40%) 0.99 Hyperlipidemia 29 (46%) 23 (53%) 6 (30%) 0.59 Obesity (BMI ≥ 30 Kg m-2) 27 (43%) 16 (37%) 11 (55%) 0.76 Diabetes 12 (19%) 10 (23%) 2 (10%) 0.83 Chronic pulmonary disease 6 (9.5%) 3 (7.0%) 3 (15%) 0.99 Chronic Heart disease 5 (7.9%) 3 (7.0%) 2 (10%) 1 Immunosuppression 3 (4.8%) 1 (2.3%) 2 (10%) 0.94 Home treatments, No. (%) ACE inhibitors 2 (3.2%) 2 (4.7%) 0 (0%) 1 Anticoagulants 2 (3.2%) 1 (2.3%) 1 (5.0%) 1 Corticosteroids 9 (14%) 5 (12%) 4 (20%) 0.99 Statins 34 (54%) 24 (56%) 10 (50%) 1 Laboratory parameters, median (IR) Lymphocyte count, /μL 550 [385–680] 580 [410–755] 475 [310–612] 0.55 Lactate dehydrogenase, U/L, 560 [358–768] 548 [364–724] 590 [340–938] 0.83 D-dimer, ng/mL, 948 [631–1740] 868 [679–1739] 974 [614–1668] 1 C-reactive protein, mg/L. 11 [4.7–18] 11 [4.6–18] 11 [6.6–22] 1 Procalcitonin, ng/mL 0.1 [0.075–0.24] 0.1 [0.065–0.22] 0.14 [0.098–0.44] 0.76 Serum Ferritin, μg/L 1130 [650–1585] 1222 [650–1585] 1028 [673–1594] 1 Initial severity of disease, median (IR) APACHE II 14 [11–17] 13 [11–16] 16 [