SCCM Resource Library-Alternative Analgesia and Sedation Strategies During Drug Shortages

Pdf Summary

The article from "Critical Connections" Fall 2021 edition addresses the increasing issue of drug shortages, particularly in critical care environments, exacerbated by the COVID-19 pandemic. It explores the multifaceted causes, including supply chain disruptions, regulatory barriers, and manufacturing challenges. The shortage profoundly impacts Intensive Care Units (ICUs), where patients frequently require sedatives and analgesics.<br /><br />To manage drug shortages, the article suggests alternative medications and strategies for analgesia and sedation in ICUs. Fentanyl, often used for sedation, is increasingly replaced with other analgesics like remifentanil, hydromorphone, morphine, and ketamine, each having its own efficacy and side effects. For instance, ketamine offers both analgesic and sedative effects, but requires higher doses for sedation.<br /><br />The piece also discusses enteral alternatives such as atypical antipsychotics (quetiapine, olanzapine, risperidone) for moderate sedation, and clonidine and methadone for managing medication weanings. Moreover, phenobarbital and valproic acid are noted as additional options, albeit with considerations for their interactions and potential side effects.<br /><br />The article highlights the importance of understanding pharmacodynamics changes in patients undergoing therapies like continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO). These therapies can significantly alter drug metabolism and clearance, necessitating careful monitoring and possible dose adjustments.<br /><br />Finally, the article emphasizes the critical need for interdisciplinary communication and knowledge of alternative treatments to mitigate the effects of drug shortages on patient care, aiming to ensure patient safety and effective treatment despite the limited availability of standard medications.

Asset Subtitle

Pharmacology, 2021, 00:14:56

Asset Caption

This article was first published in the Fall 2021 issue of Critical Connections.
Supply chain issues are making drug shortage more common. Know the alternative medications and routes of administration to continue providing quality care.

National tracking of drug shortages started in 2001, and the past decade has seen significant increases in drug shortages. The causes are likely multifactorial, ranging from lack of raw materials to manufacturing problems, regulatory barriers, and quality control difficulties in the supply chain. Furthermore, the COVID-19 pandemic has placed more strain on an already strained system of drug shortages due to the need for prolonged continuous sedation in COVID-19 patients compared to non-COVID-19 patients.

Critical Connections is the critical care industry’s only newsmagazine, provides information on cutting-edge topics in critical care useful to the entire multiprofessional team.

Authors: Adrian Wong, PharmD, MPH, BCCCP
Nathan J. Smischney, MD, MSc

Meta Tag

Content Type Article

Knowledge Area Pharmacology

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Analgesia and Sedation

Tag Pharmacokinetics Pharmacodynamics

Year 2021

Keywords

drug shortages

critical care

COVID-19 pandemic

supply chain disruptions

ICUs

alternative medications

analgesics

sedation

pharmacodynamics

interdisciplinary communication

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