tetano
Editor, Senior Moderator
World J Crit Care Med
. 2021 Nov 9;10(6):323-333.
doi: 10.5492/wjccm.v10.i6.323.
Extracorporeal membrane oxygenation and inhaled sedation in coronavirus disease 2019-related acute respiratory distress syndrome
Martin Bellgardt[SUP] 1 [/SUP], Dennis Özcelik[SUP] 2 [/SUP], Andreas Friedrich Christoph Breuer-Kaiser[SUP] 3 [/SUP], Claudia Steinfort[SUP] 4 [/SUP], Thomas Georg Karl Breuer[SUP] 5 [/SUP], Thomas Peter Weber[SUP] 3 [/SUP], Jennifer Herzog-Niescery[SUP] 3 [/SUP]
Affiliations
Abstract
Coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome (ARDS) is a severe complication of infection with severe acute respiratory syndrome coronavirus 2, and the primary cause of death in the current pandemic. Critically ill patients often undergo extracorporeal membrane oxygenation (ECMO) therapy as the last resort over an extended period. ECMO therapy requires sedation of the patient, which is usually achieved by intravenous administration of sedatives. The shortage of intravenous sedative drugs due to the ongoing pandemic, and attempts to improve treatment outcome for COVID-19 patients, drove the application of inhaled sedation as a promising alternative for sedation during ECMO therapy. Administration of volatile anesthetics requires an appropriate delivery. Commercially available ones are the anesthetic gas reflection systems AnaConDa[SUP]®[/SUP] and MIRUS[SUP]TM[/SUP], and each should be combined with a gas scavenging system. In this review, we describe respiratory management in COVID-19 patients and the procedures for inhaled sedation during ECMO therapy of COVID-19 related ARDS. We focus particularly on the technical details of administration of volatile anesthetics. Furthermore, we describe the advantages of inhaled sedation and volatile anesthetics, and we discuss the limitations as well as the requirements for safe application in the clinical setting.
Keywords: Acute respiratory distress syndrome; COVID-19; Critical care; Extracorporeal membrane oxygenation; Inhaled sedation; Volatile anesthetics.
. 2021 Nov 9;10(6):323-333.
doi: 10.5492/wjccm.v10.i6.323.
Extracorporeal membrane oxygenation and inhaled sedation in coronavirus disease 2019-related acute respiratory distress syndrome
Martin Bellgardt[SUP] 1 [/SUP], Dennis Özcelik[SUP] 2 [/SUP], Andreas Friedrich Christoph Breuer-Kaiser[SUP] 3 [/SUP], Claudia Steinfort[SUP] 4 [/SUP], Thomas Georg Karl Breuer[SUP] 5 [/SUP], Thomas Peter Weber[SUP] 3 [/SUP], Jennifer Herzog-Niescery[SUP] 3 [/SUP]
Affiliations
- PMID: 34888158
- PMCID: PMC8613718
- DOI: 10.5492/wjccm.v10.i6.323
Abstract
Coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome (ARDS) is a severe complication of infection with severe acute respiratory syndrome coronavirus 2, and the primary cause of death in the current pandemic. Critically ill patients often undergo extracorporeal membrane oxygenation (ECMO) therapy as the last resort over an extended period. ECMO therapy requires sedation of the patient, which is usually achieved by intravenous administration of sedatives. The shortage of intravenous sedative drugs due to the ongoing pandemic, and attempts to improve treatment outcome for COVID-19 patients, drove the application of inhaled sedation as a promising alternative for sedation during ECMO therapy. Administration of volatile anesthetics requires an appropriate delivery. Commercially available ones are the anesthetic gas reflection systems AnaConDa[SUP]®[/SUP] and MIRUS[SUP]TM[/SUP], and each should be combined with a gas scavenging system. In this review, we describe respiratory management in COVID-19 patients and the procedures for inhaled sedation during ECMO therapy of COVID-19 related ARDS. We focus particularly on the technical details of administration of volatile anesthetics. Furthermore, we describe the advantages of inhaled sedation and volatile anesthetics, and we discuss the limitations as well as the requirements for safe application in the clinical setting.
Keywords: Acute respiratory distress syndrome; COVID-19; Critical care; Extracorporeal membrane oxygenation; Inhaled sedation; Volatile anesthetics.