Covid sedation thought

[gasdoc77]

I'm old hat and (once upon a time) covered small community ICU's in a day before it required a fellowship.

We know Covid patients do abysmally after intubation.

Curious if anyone is aware of literature to suggest that the choice of sedation may be associated with outcome(s). We are aware of frank Propofol infusion syndrome, but is it possible that subclinical mitochondrial dysfunction related to the soybean oil lipid emulsion could be contributing to the negative outcomes

Conversely, some anecdotes suggest an autonomic component to Covid. If that proves correct, would precedex better modulate the ANS and be associated with better prognosis. All of this is hypothetical.

Obviously correlation doesn't equal causation.

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[deleted875186]

What

 

[fakin' the funk]

I think you meant "we all know that patients who have severe enough COVID ARDS to necessitate intubation and ventilation do abysmally"

And no

 

[nimbus]

Here’s one comparing propofol vs dexmedetomidine in sepsis. No difference.

https://www.nejm.org/doi/full/10.1056/NEJMoa2024922

 

[Radetzky]

The only thing about sedation that probably affects mortality is not overdoing it. The probability that choice of agent affects mortality in any condition approaches zero.

 

[gasdoc77]

(PDF) Toxicity of a Soybean Oil Emulsion on Human Lymphocytes and Neutrophils

PDF | The incorporation of lipid emulsions in parenteral diets is a requirement for energy and essential fatty acid supply to critically ill patients.... | Find, read and cite all the research you need on ResearchGate

www.researchgate.net

 

[abolt18]

Walking Home From The ICU • A podcast on Anchor

Kali Dayton, DNP, ACNP-BC, is an ICU nurse practitioner and ICU consultant. She hands the microphone to ICU survivors and bedside caregivers to reveal the realities of ICU experience and patients' journeys after discharge. The big picture of sedation and immobility is discussed and we explore...

anchor.fm

Intriguing podcast called "Walking Home From The ICU" that may make you question our approach to sedation in the ICU.

 

[jwk]

Walking Home From The ICU • A podcast on Anchor

Kali Dayton, DNP, ACNP-BC, is an ICU nurse practitioner and ICU consultant. She hands the microphone to ICU survivors and bedside caregivers to reveal the realities of ICU experience and patients' journeys after discharge. The big picture of sedation and immobility is discussed and we explore...

anchor.fm

Intriguing podcast called "Walking Home From The ICU" that may make you question our approach to sedation in the ICU.

I don't listen to podcasts, but one from ACNP-BC probably wouldn't be high on my list.

 

[abolt18]

I don't listen to podcasts, but one from ACNP-BC probably wouldn't be high on my list.

I found it to simply be insightful. Opened my eyes to a different way of doing things. It provides a window into a pulm ICU that doesn't sedate their patients (except when needing to paralyze/prone). They walk all their patients on the vent to keep up strength and muscle mass. Very few patients end up with a trach/peg. Very different from anything I experienced in the ICUs.

 

[deleted875186]

I found it to simply be insightful. Opened my eyes to a different way of doing things. It provides a window into a pulm ICU that doesn't sedate their patients (except when needing to paralyze/prone). They walk all their patients on the vent to keep up strength and muscle mass. Very few patients end up with a trach/peg. Very different from anything I experienced in the ICUs.

Thats because it takes intensive nursing effort to do stuff like this. Most ICUs I’ve been in just do sedation because it’s easier for nursing.

 

[abolt18]

Thats because it takes intensive nursing effort to do stuff like this. Most ICUs I’ve been in just do sedation because it’s easier for nursing.

And that is discussed in detail. Definitely a lot more work, but less issues with PTSD related to sedation induced delirium, less muscle atrophy, less "trach, peg, rehab" sounds pretty intriguing.

 

[GassYous]

I found it to simply be insightful. Opened my eyes to a different way of doing things. It provides a window into a pulm ICU that doesn't sedate their patients (except when needing to paralyze/prone). They walk all their patients on the vent to keep up strength and muscle mass. Very few patients end up with a trach/peg. Very different from anything I experienced in the ICUs.

There are places that walk patients on ecmo. They have like five staff members accompanying them

 

[POW16]

Yeah I've heard something like that on a different podcast. It might even have been her. That's nice and all but usually (pre-COVID) there is barely enough staff to get the non intubated patients out of bed and walking around.