INTRODUCTION
Sedation plays a key role in the management of pain, anxiety, and agitation which are important problems for the patients treated in the ICUs. It becomes very difficult to apply frequently used procedures in the ICUs such as high flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and continuous intravenous (IV) fluid/drug infusions which require high levels of cooperation to an agitated and anxious patient. Thus,
sedative agents are usually applied to render patients calmer, more cooperative, and communicable (2).
Providing effective sedation is of vital importance not only in the setting of ICU but also in surgical procedures since perioperative stress and inflammation might contribute to postoperative complications (1). Surgical trauma induces a variety of stress responses including the release of stress hormones such as catecholamines and cortisol and inflammatory mediators such as interleukins and tumor necrosis factor-α. It may also cause immune dysfunction via CD4 T cells and all of these factors might contribute to increased risk of delayed wound healing, postoperative infections, morbidity, and mortality (1). Therefore, discovering multimodal therapies containing anxiolytic, analgesic, anesthetic, sedative, and immunomodulatory effects at the same time, is extremely important to resolve the aforementioned problems in the setting of ICU and surgery (3).
Dexmedetomidine (DEX) is a highly selective α2-adrenoceptor agonist that is increasingly used in the daily practice of intensive care units (ICUs) with its sedative, analgesic, anxiolytic, and immunoprotective effects (1) (2). The sedative effect of DEX might vary from minimal to deep depending on the dose applied to the patient. It is also known for its potential analgesic potential since it causes a reduction of sympathetic tone. Due to this fact, it can also be used for procedural sedation with high patient and operator satisfaction (4). DEX can maintain lighter sedation compared to propofol and benzodiazepines (i.e. midazolam and lorazepam) and since the light level of sedation is recommended in ICU when possible, DEX would be preferred over other agents (2) (5). Patients under the DEX effect can be awakened easily when needed, and communicate pain, however, when left undisturbed will fall back into a state very similar to natural sleep (4) (5). These unique properties aroused scientists’ interests and were found to be associated with improved outcomes, including a shorter duration of ventilation and a shorter ICU stay in some studies (6).
A novel Coronavirus disease caused by SARS-CoV-2 was first detected in China in December 2019 and has become a pandemic causing the fatality of millions of people so far. A relevant part of the infected patients might present with acute respiratory distress syndrome (ARDS) and must be treated in ICUs (7) (8). Since evolving data reported high mortality rates for intubated patients, delaying or avoiding intubation as much as possible with non-invasive mechanical ventilation (NIMV) methods such as HFNC and CPAP especially with prone positioning has been the management of choice for a long time for patients with severe respiratory failure (9) (10). Besides, states of impaired consciousness, including delirium might occur in up to 15% of the patients with severe COVID-19 and is associated with a poorer prognosis (11). Therefore, considering the high frequency of respiratory failure and delirium in patients with severe COVID-19, it is obvious that proper agents with sedative, analgesic and anxiolytic effects are highly required in the setting of ICU. At this point, it can be hypothesized that DEX would be an important part of the treatment in COVID-19 due to its beforementioned potential beneficial effects, especially for the patients in ICU. Theoretically, it would increase the compliance of patients to treatments with its sedative effect while decreasing the inflammation with its potential immunomodulatory effect. In this study, we aimed to analyze whether Dexmedetomidine improves the outcomes in patients treated in ICU.