Sedation Practices for Intubated Patients with COVID-19 and non-COVID-19 Acute Respiratory Distress Syndrome and its Effects on Clinical Outcomes

Objective To compare the sedation practices of adult intubated patients with COVID-19-related Acute Respiratory Distress Syndrome (C-ARDS) and ARDS from other causes, and their impact on clinical outcomes in a tertiary hospital. Methods We performed a retrospective cohort on the sedation practices of adult intubated patients with C-ARDS and non-C-ARDS admitted to the intensive care unit of a tertiary hospital from January 2021 to December 2021. Electronic medical records were reviewed to obtain sedative use, sedative dosages, clinical outcomes, and complications. Results Among the 150 included patients, 112 had C-ARDS, and 38 had non-C-ARDS. The C-ARDS group showed a significant difference with the non-C-ARDS group in terms of BMI (24.11 vs. 21.09 kg/m2, p<0.001), use of higher PEEP (16 vs. 10, p<0.001), and prone positioning (40.18% vs 2.63%, p<0.01). In terms of sedation practice, C-ARDS patients targeted deeper RASS scores (p=0.038), with a significantly higher proportion receiving more than one sedative (82.14% vs. 18.42, p<0.001) than non-C-ARDS patients. Sedation doses for midazolam (78 mg/d vs. 36 mg/d; p=0.01) and propofol (mean 2626±1312.97 mg/d vs. 1742±380.99 mg/d; p=0.007), were significantly higher among C-ARDS versus non-C-ARDS group. Duration of hospitalization (9 vs. 20 days; p<0.001) and ventilator use (7 vs. 14.50 days; p<0.001) were significantly shorter in the C-ARDS group, albeit with a high mortality (100% vs. 89.47%; p=0.004). Shock-requiring pressor was significantly associated with multiple sedation use [OR=15.11 (1.52-2032.89); p=0.017] and combination use of benzodiazepine and non-benzodiazepines [OR=11.51 (1.17-1541.91); p=0.034] in the C-ARDS but not the C-ARDS group. Conclusion Patients with C-ARDS had higher sedation requirements in terms of dosage and number of sedatives. The use of multiple sedatives was significantly associated with shock-requiring pressor. We recommend the development of a sedation protocol to guide sedation practices and monitoring of complications in the critically ill.