{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:12:06Z","timestamp":1790748726069,"version":"4.1.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"21","license":[{"start":{"date-parts":[[2021,5,16]],"date-time":"2021-05-16T00:00:00Z","timestamp":1621123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,25]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Preliminary reports suggest that critically ill patients with coronavirus disease 2019 (COVID-19) infection requiring mechanical ventilation may have markedly increased sedation needs compared with critically ill, mechanically ventilated patients without COVID-19. We conducted a study to examine sedative use for this patient population within multiple intensive care units (ICUs) of a large academic medical center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective, single-center cohort study of sedation practices for critically ill patients with COVID-19 during the first 10 days of mechanical ventilation was conducted in 8 ICUs at Massachusetts General Hospital, Boston, MA. The study population was a sequential cohort of 86 critically ill, mechanically ventilated patients with COVID-19. Data characterizing the sedative medications, doses, drug combinations, and duration of administration were collected daily and compared to published recommendations for sedation of critically ill patients without COVID-19. The associations between drug doses, number of drugs administered, baseline patient characteristics, and inflammatory markers were investigated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the study cohort, propofol and hydromorphone were the most common initial drug combination, with these medications being used on a given day in up to 100% and 88% of patients, respectively. The doses of sedative and analgesic infusions increased for patients over the first 10 days, reaching or exceeding the upper limits of published dosage guidelines for propofol (48% of patients), dexmedetomidine (29%), midazolam (7.7%), ketamine (32%), and hydromorphone (38%). The number of sedative and analgesic agents simultaneously administered increased over time for each patient, with more than 50% of patients requiring 3 or more agents by day 2. Compared with patients requiring 3 or fewer agents, patients requiring more than 3 agents were of younger age, had an increased body mass index, had increased serum ferritin and lactate dehydrogenase concentrations, had a lower Pao2:Fio2 (ratio of arterial partial pressure of oxygen to fraction of inspired oxygen), and were more likely to receive neuromuscular blockade.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our study confirmed the clinical impression of elevated sedative use in critically ill, mechanically ventilated patients with COVID-19 relative to guideline-recommended sedation practices in other critically ill populations.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ajhp\/zxab202","type":"journal-article","created":{"date-parts":[[2021,5,16]],"date-time":"2021-05-16T14:38:31Z","timestamp":1621175911000},"page":"1952-1961","source":"Crossref","is-referenced-by-count":28,"title":["An examination of sedation requirements and practices for mechanically ventilated critically ill patients with COVID-19"],"prefix":"10.1093","volume":"78","author":[{"given":"Aditi","family":"Balakrishna","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa C","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"},{"name":"Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arzo","family":"Hamidi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheri","family":"Berg","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Austin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard M","family":"Pino","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dusan","family":"Hanidziar","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marvin G","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward A","family":"Bittner","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,5,16]]},"reference":[{"key":"2021102510242707600_CIT0001","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1007\/s00134-020-05942-6","article-title":"Respiratory drive in the acute respiratory distress syndrome: pathophysiology, monitoring, and therapeutic interventions","volume":"46","author":"Spinelli","year":"2020","journal-title":"Intensive Care Med"},{"key":"2021102510242707600_CIT0002","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/s13613-019-0540-9","article-title":"Formal guidelines: management of acute respiratory distress syndrome","volume":"9","author":"Papazian","year":"2019","journal-title":"Ann Intensive Care."},{"key":"2021102510242707600_CIT0003","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.chest.2016.10.040","article-title":"Neuromuscular blockade in the 21st century management of the critically ill patient","volume":"151","author":"deBacker","year":"2017","journal-title":"Chest"},{"key":"2021102510242707600_CIT0004","doi-asserted-by":"crossref","first-page":"e40","DOI":"10.1213\/ANE.0000000000004887","article-title":"Sedation of mechanically ventilated COVID-19 patients: challenges and special considerations","volume":"131","author":"Hanidziar","year":"2020","journal-title":"Letter. 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