211: Sedation Requirements and Practices for Mechanically Ventilated Critically Ill COVID-19 Patients

INTRODUCTION: Preliminary reports suggest that critically ill patients with SARS-CoV-2 (COVID-19) infection requiring mechanical ventilation may have markedly increased sedation needs compared with non-COVID-19 mechanically ventilated patients This study examines the sedative practices for this patient population within multiple ICUs of a large academic medical center METHODS: A retrospective cohort study of sedation practices for a sequential cohort of 86 critically ill, mechanically ventilated patients with COVID-19 during the first 10 days of mechanical ventilation across eight intensive care units at the Massachusetts General Hospital, Boston, MA Data characterizing the sedative medications, doses, drug combinations, and duration of administration were collected daily and compared to published recommendations for critically ill patients without COVID-19 The association between drug doses, number of drugs administered, baseline patient characteristics, and inflammatory markers were investigated RESULTS: Among the study cohort, propofol and hydromorphone were the most common initial drug combination, with up to 100% and 88% of patients receiving these medications on a given day The doses of sedative and analgesic infusions increased over the study period, reaching or exceeding the upper limits of published guidelines for propofol (48% of patients), dexmedetomidine (29%), midazolam (7 7%), ketamine (32%), and hydromorphone (38%) The number of sedative and analgesic agents simultaneously administered increased over time, with > 50% of patients requiring 3 or more agents by day 2 Variables associated with this requirement were younger age, increased body mass index (BMI), increased ferritin, increased LDH, lower P/F ratio, and the use of neuromuscular blockade CONCLUSIONS: Our study confirms the clinical impression of increased sedative requirements in critically ill, mechanically ventilated patients with COVID-19 The impact of increased sedation administration on clinical outcomes and the optimal sedation regimen for this patient population remains unknown and warrants further investigation