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Sedation Practice in Extracorporeal Membrane Oxygenation–Treated Patients with Acute Respiratory Distress Syndrome: A Retrospective Study

deBacker, Julian*,†; Tamberg, Erik; Munshi, Laveena; Burry, Lisa; Fan, Eddy§; Mehta, Sangeeta

doi: 10.1097/MAT.0000000000000658
Clinical Critical Care

Our objective was to characterize sedation management in adult patients with severe respiratory distress syndrome (ARDS) treated with venovenous extracorporeal membrane oxygenation (VV-ECMO). We conducted a retrospective chart review of these patients treated at Toronto General Hospital between January 2012 and October 2015. Medications administered (sedative, analgesic, paralytic, and antipsychotic), sedation depth (Sedation Agitation Scale [SAS] score) delirium assessments, and mobilization were recorded daily. Forty-five adults (33 males, median age 47 years; interquartile range [IQR], 35–56]) with ARDS (median PaO2/FiO2 71; IQR 59–83) because of respiratory infection (91%) were treated with VV-ECMO for a median of 11 days (IQR, 7–17). After ECMO initiation, 96% patients were deeply sedated (SAS score < 3) with continuous infusions of midazolam (49%), propofol (18%), or both (29%) and 98% were receiving opioid infusions (93% fentanyl). Patients were deeply sedated for a median of 6 days (IQR, 3–10) after cannulation before transitioning to intermediate or light sedation (SAS score ≥ 3). Before ECMO discontinuation, 77% of surviving patients were intermediately or lightly sedated, 20% were receiving no sedatives, and 9% were receiving no opioids. During ECMO, 58% had positive delirium assessment and 24% experienced agitation (SAS ≥ 6). During ECMO support, 71% received physical therapy that occurred after a median of 7 days (IQR, 4–12) after cannulation. In conclusion, we found that although patients were deeply sedated for a prolonged duration after VV-ECMO initiation, many were able to safely achieve light sedation and active mobilization.

From the *Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio

Department of Medicine and Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada

Sinai Health System and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada

§Department of Medicine and Interdepartmental Division of Critical Care Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada.

Submitted for consideration December 2016; accepted for publication in revised form August 2017

This article has not been published in whole or part elsewhere, although an abstract of the preliminary findings has been published in a supplement of Critical Care (deBacker J, Munshi L, Burry L, Fan E, Mehta S. "Sedation and analgesia practice in extracorporeal membrane oxygenation (ECMO)-treated patients with acute respiratory distress syndrome (ARDS): a retrospective study". Critical Care, 2016; 20(S2), 107). The article is not currently in submission elsewhere. The study was approved by the Research Ethics Board of the University Health Network in Toronto, Ontario. The authors accept that Copyright in the manuscript will pass to the American Society for Artificial Internal Organs if the manuscript is accepted for publication.

Disclosure: The authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Dr. Julian deBacker (under the supervision of Dr. Sangeeta Mehta), Mount Sinai Hospital, 600 University Ave, Toronto, ON M5G 1X5, Canada. Email: debacker.jw@gmail.com.

Copyright © 2018 by the American Society for Artificial Internal Organs