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.