Scienceline Publication Journal of Life Science and Biomedicine 2251-9939 11 5 2021 11 25 Dexmedetomidine for sedation and correction of psychoemotional disorders in critically ill patients with COVID-19 80 87 10.51145/jlsb.2021.10 EN Ravshan Aliyevich IBADOV Intensive Care Unit, Republican Specialized Scientific-Practical Medical Center of Surgery Named after Academician V.Vakhidov, Tashkent, Uzbekistan Anvar Shamkhatovich ARIFJANOV Intensive Care Unit, Republican Specialized Zangiota-1 Hospital for COVID-19, Tashkent region, Uzbekistan Sardor Khamdamovich IBRAGIMOV Intensive Care Unit, Republican Specialized Scientific-Practical Medical Center of Surgery Named after Academician V.Vakhidov, Tashkent, Uzbekistan Begali Bobokulovich KHAKIMOV Intensive Care Unit, Republican Specialized Zangiota-2 Hospital for COVID-19, Tashkent region, Uzbekistan Journal Article S225199392100010-11 10.51145/jlsb.2021.10 2021 07 30 2021 09 25 2021 09 25 The objective of this study was to evaluate sedation therapy effectiveness in critically ill patients with severe COVID-19 who received dexmedetomidine compared to propofol. The research was done in a prospective single center to a cohort study of critically ill 333 adult patients with COVID-19 and psychoemotional disorders (depression, anxiety and posttraumatic stress disorder) admitted in the ICU of the Republican Specialized Hospital for COVID-19 in Uzbekistan. Patients were non-invasive ventilated more than 24 hours and received intravenous sedation with dexmedetomidine or propofol. The risk of progression of the pathological process decreased from 47.6 % to 21.8 % and accordingly, the proportion of patients with stabilization and improvement of their condition increased from 52.4 % to 79.4 %.... In the presence of severe psychoemotional disorders, the effectiveness of etiotropic and pathogenetic treatment protocols of COVID-19 directly depends on the proper sedation regimen. In this aspect, dexmedetomidine provides adequate and safe respiratory support with an improvement in external respiration, blood gas composition and a minimal negative hemodynamic effect. World Health Organization. COVID-19 clinical management: living guidance (25 January 2021). Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med. 2020; 382:2268-70. PMC7179967 32294339 10.1056/NEJMc2008597 Favas TT, Dev P, Chaurasia RN, Chakravarty K, Mishra R, Joshi D et al. Neurological manifestations of COVID-19: a systematic review and meta-analysis of proportions. Neurol Sci. 2020; 41(12):3437-3470. PMC7577367 33089477 10.1007/s10072-020-04801-y Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020; 77(6):683-690. 32275288 PMC7149362 10.1001/jamaneurol.2020.1127 Shenoy N, Luchtel R, Gulani P. Considerations for target oxygen saturation in COVID-19 patients: are we under-shooting? BMC Med. 2020; 18(1):260. 32814566 PMC7437106 10.1186/s12916-020-01735-2 Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, Kneen R, Defres S, Sejvar J, Solomon T. Neurological associations of COVID-19. Lancet Neurol. 2020 Sep; 19(9):767-783. PMC7332267 32622375 10.1016/S1474-4422(20)30221-0 Kotfis K, Roberson SW, Wilson JE, Dabrowski W, Pun BT, Ely EW. COVID-19: ICU delirium management during SARS-CoV-2 pandemic. Critical care. 2020 Dec; 24(1):1-9. PMC7186945 32345343 10.1186/s13054-020-02882-x Karamchandani K, Dalal R, Patel J, Modgil P, Quintili A. Challenges in Sedation Management in Critically Ill Patients with COVID-19: a Brief Review. Curr Anesthesiol Rep. 2021; 26:1-9. PMC7907309 33654458 10.1007/s40140-021-00440-x Hanidziar D, Bittner EA. Sedation of Mechanically Ventilated COVID-19 Patients: Challenges and Special Considerations. Anesth Analg. 2020 Jul; 131(1):e40-e41. PMC7179055 32392023 10.1213/ANE.0000000000004887 Devaud JC, Berger MM, Pannatier A, Marques-Vidal P, Tappy L, Rodondi N, Chiolero R, Voirol P. Hypertriglyceridemia: a potential side effect of propofol sedation in critical illness. Intensive Care Med. 2012 Dec; 38(12):1990-8. 23052949 10.1007/s00134-012-2688-8 Meng M, Chen L, Zhang S, Dong X, Li W, Li R, Deng Y, Wang T, Xu Y, Liu J, Huang Y, Chen Y, Huang S, Wen Z, Zhang L, Du H, Liu Y, Annane D, Qu J, Chen D. Risk factors for secondary hemophagocytic lymphohistiocytosis in severe coronavirus disease 2019 adult patients. BMC Infect Dis. 2021 Apr 29; 21(1):398. PMC8084265 33926377 10.1186/s12879-021-06094-8 Pandharipande P, Shintani A, Peterson J, Pun BT, Wilkinson GR, Dittus RS, Bernard GR, Ely EW. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006 Jan; 104(1):21-6. 16394685 10.1097/00000542-200601000-00005 Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004 Apr 14; 291(14):1753-62. 15082703 10.1001/jama.291.14.1753 Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, Brummel NE, Hughes CG, Vasilevskis EE, Shintani AK, Moons KG, Geevarghese SK, Canonico A, Hopkins RO, Bernard GR, Dittus RS, Ely EW; BRAIN-ICU Study Investigators. Long-term cognitive impairment after critical illness. N Engl J Med. 2013 Oct 3; 369(14):1306-16. PMC3922401 24088092 10.1056/NEJMoa1301372 Lonardo NW, Mone MC, Nirula R, Kimball EJ, Ludwig K, Zhou X, Sauer BC, Nechodom K, Teng C, Barton RG. Propofol is associated with favorable outcomes compared with benzodiazepines in ventilated intensive care unit patients. Am J Respir Crit Care Med. 2014 Jun 1;1 89(11):1383-94. PMC4153410 24720509 10.1164/rccm.201312-2291OC Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, Wu Y, Zhang L, Yu Z, Fang M, Yu T, Wang Y, Pan S, Zou X, Yuan S, Shang Y. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020 May; 8(5):475-481. PMC7102538 32105632 10.1016/S2213-2600(20)30079-5 17. Pun BT, Badenes R, Heras La Calle G, Orun OM, Chen W, et al. Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study. Lancet Respir Med. 2021 Mar; 9(3):239-250. PMC7832119 33428871 10.1016/S2213-2600(20)30552-X 18. Pasin L, Landoni G, Nardelli P, Belletti A, Di Prima AL, Taddeo D, Isella F, Zangrillo A. Dexmedetomidine reduces the risk of delirium, agitation and confusion in critically Ill patients: a meta-analysis of randomized controlled trials. J Cardiothorac Vasc Anesth. 2014 Dec; 28(6):1459-66. 25034724 10.1053/j.jvca.2014.03.010 19. Ju T, Lee CC, Chen WC, Lin HT. Use of dexmedetomidine in critically ill patients receiving noninvasive ventilation: a meta-analysis of randomized controlled trials. Chest. 2020; 158(4):A577. 10.1016/j.chest.2020.08.545