AUTHOR=Simioli Francesca , Annunziata Anna , Coppola Antonietta , Imitazione Pasquale , Mirizzi Angela Irene , Marotta Antonella , D’Angelo Rossella , Fiorentino Giuseppe 

TITLE=The role of dexmedetomidine in ARDS: an approach to non-intensive care sedation

JOURNAL=Frontiers in Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1224242

DOI=10.3389/fmed.2023.1224242

ISSN=2296-858X

ABSTRACT=<sec id="sec1"><title>Introduction</title><p>Severe COVID-19 is a life-threatening condition characterized by complications such as interstitial pneumonia, hypoxic respiratory failure, and acute respiratory distress syndrome (ARDS). Non-pharmacological intervention with mechanical ventilation plays a key role in treating COVID-19-related ARDS but is influenced by a high risk of failure in more severe patients. Dexmedetomidine is a new generation highly selective α2-adrenergic receptor (α2-AR) agonist that provides sedative effects with preservation of respiratory function. The aim of this study is to assess how dexmedetomidine influences gas exchange during non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) in moderate to severe ARDS caused by COVID-19 in a non-intensive care setting.</p></sec><sec id="sec2"><title>Methods</title><p>This is a single center retrospective cohort study. We included patients who showed moderate to severe respiratory distress. All included subjects had indication to NIV and were suitable for a non-intensive setting of care. A total of 170 patients were included, divided in a control group (<italic>n</italic> = 71) and a treatment group (DEX group, <italic>n</italic> = 99).</p></sec><sec id="sec3"><title>Results</title><p>A total of 170 patients were hospitalized for moderate to severe ARDS and COVID-19. The median age was 71 years, 29% females. The median Charlson comorbidity index (CCI) was 2.5. Obesity affected 21% of the study population. The median pO<sub>2</sub>/FiO<sub>2</sub> was 82 mmHg before treatment. After treatment, the increase of pO<sub>2</sub>/FiO<sub>2</sub> ratio was clinically and statistically significant in the DEX group compared to the controls (125 mmHg [97–152] versus 94 mmHg [75–122]; ***<italic>p</italic> &lt; 0.0001). A significative reduction of NIV duration was observed in DEX group (10 [7–16] days vs. 13 [10–17] days; *<italic>p</italic> &lt; 0.02). Twenty four patients required IMV in control group (<italic>n</italic> = 71) and 16 patients in DEX group (<italic>n</italic> = 99) with a reduction of endotracheal intubation of 62% (OR 0.38; **<italic>p</italic> &lt; 0.008). A higher incidence of sinus bradycardia was observed in the DEX group.</p></sec><sec id="sec4"><title>Conclusion</title><p>Dexmedetomidine provides a “calm and arousal” status which allows spontaneous ventilation in awake patients treated with NIV and HFNC. The adjunctive therapy with dexmedetomidine is associated with a higher pO<sub>2</sub>/FiO<sub>2</sub>, lower duration of NIV, and a lower risk of NIV failure. A higher incidence of sinus bradycardia needs to be considered.</p></sec>