Variation in Sedative and Analgesic Use During the COVID-19 Pandemic and Associated Outcomes

Area of Science:

• Critical Care Medicine
• Pharmacology
• Infectious Diseases

Background:

• Analgesia and sedation are crucial for mechanically ventilated patients.
• Sedation practices during the COVID-19 pandemic and their outcomes require further characterization.

Purpose of the Study:

• To examine hospital patterns of analgesic and sedative use in COVID-19 patients receiving mechanical ventilation (MV).
• To assess differences in clinical patient outcomes across various sedation practices.

Main Methods:

• An observational cohort study of 1,313 adult COVID-19 patients on MV across 35 hospitals (February 2020 - April 2021).
• Hierarchical clustering to group hospitals by sedation medication patterns.
• Multivariable regression to analyze the association between sedation clusters and duration of MV, accounting for death.

Main Results:

• Two distinct sedation practice clusters emerged: Cluster 1 (opioids, propofol, other sedatives) and Cluster 2 (opioids, benzodiazepines).
• Patients in Cluster 1 hospitals had a shorter adjusted median duration of MV with placement of death (POD) (-5.9 days, P=.03) compared to Cluster 2.

Conclusions:

• Hospitals prioritizing opioids and propofol for COVID-19 patients on MV demonstrated shorter adjusted median MV duration with POD.
• Sedation strategies significantly influence patient outcomes in mechanically ventilated COVID-19 populations.