SCCM Resource Library-Intubation Medications/Sedation Requirements for Intubating COVID-19 Patient

Pdf Summary

The document provides guidelines for intubation and sedation management in COVID-19 patients, emphasizing the use of both induction and neuromuscular blocking agents, with usual or slightly higher RSI medication doses to optimize first-pass success. It highlights the necessity of rapid sequence intubation (RSI), early aggressive analgesia, sedation, and potential vasopressor use peri-intubation. <br /><br />Post-RSI, aggressive sedation titration is advised, especially during prone positioning or ventilator dysynchrony, with continuous monitoring of PaO2/FiO2 ratios and tidal volume/respiratory rate. If sedation proves inadequate, a single neuromuscular blocking agent dose may be tested before starting a continuous infusion. The document anticipates delirium from aggressive sedation and advises early screening/intervention, emphasizing the importance of weaning down sedation to avoid prolonged high infusion rates.<br /><br />Interdisciplinary decision-making is recommended for medication weaning, particularly in drug shortages, to prevent waste by using entire infusion bags. Logistical considerations include concentrating infusions for fluid overload patients in collaboration with pharmacy and nursing to prevent errors. Extending line change schedules is also suggested to reduce wastage.<br /><br />Continuous infusion agents are preferred over intermittent dosing, with deeper sedation goals to avoid self-extubation and emergent in-room care. Smart infusion pumps are suggested to remain external to the patient's room, noting that longer tubing requires higher priming volume.<br /><br />The document lists specific medications like Etomidate, Ketamine, Midazolam, Fentanyl, Succinylcholine, Rocuronium, and Vecuronium for intubation and advises on being familiar with alternative agents amid drug shortages. These guidelines aim at minimizing staff exposure and ensuring effective care delivery during the intubation and sedation of COVID-19 patients.

Asset Subtitle

Crisis Management, Pharmacology, Procedures, 2020, 0:02:00

Asset Caption

"This resource is an infographic that details intubation medications and sedation requirement for intubating COVID-19 patients.

This is a community developed COVID-19 microlearning resource."

Meta Tag

Content Type Guidelines

Knowledge Area Crisis Management

Knowledge Area Pharmacology

Knowledge Area Procedures

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Nonmember

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag COVID-19

Tag Analgesia and Sedation

Tag Airway Management

Year 2020

Keywords

intubation

sedation management

COVID-19

rapid sequence intubation

neuromuscular blocking agents

analgesia

medication weaning

smart infusion pumps

Etomidate

drug shortages

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