Bellgardt M, Özcelik D, Breuer-Kaiser AFC, Steinfort C, Breuer TGK, Weber TP, Herzog-Niescery J. Extracorporeal membrane oxygenation and inhaled sedation in coronavirus disease 2019-related acute respiratory distress syndrome. World J Crit Care Med 2021; 10(6): 323-333 [PMID: 34888158 DOI: 10.5492/wjccm.v10.i6.323]
Corresponding Author of This Article
Martin Bellgardt, MD, Academic Research, Senior Scientist, Staff Physician, Anesthesia and Intensive Care Medicine, St. Josef-Hospital, University Hospital of Ruhr-University of Bochum, Gudrunstr. 56, Bochum 44791, Germany. martin.bellgardt@rub.de
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Nov 9, 2021; 10(6): 323-333 Published online Nov 9, 2021. doi: 10.5492/wjccm.v10.i6.323
Extracorporeal membrane oxygenation and inhaled sedation in coronavirus disease 2019-related acute respiratory distress syndrome
Martin Bellgardt, Dennis Özcelik, Andreas Friedrich Christoph Breuer-Kaiser, Claudia Steinfort, Thomas Georg Karl Breuer, Thomas Peter Weber, Jennifer Herzog-Niescery
Martin Bellgardt, Andreas Friedrich Christoph Breuer-Kaiser, Thomas Peter Weber, Jennifer Herzog-Niescery, Anesthesia and Intensive Care Medicine, St. Josef-Hospital, University Hospital of Ruhr-University of Bochum, Bochum 44791, Germany
Dennis Özcelik, Chemistry | Biology | Pharmacy Information Center, ETH Zürich, Zürich 8093, Switzerland
Claudia Steinfort, General and Visceral Surgery, St. Josef-Hospital, University Hospital of Ruhr-University of Bochum, Bochum 44791, Germany
Thomas Georg Karl Breuer, Internal Medicine/Intensive Care, St. Josef-Hospital, University Hospital of Ruhr-University of Bochum, Bochum 44791, Germany
Author contributions: Bellgardt M designed and conceptualized this work; Bellgardt M, Özcelik D, and Herzog-Niescery J conducted the literature review and information retrieval and contributed to critical revision for important intellectual content; All authors wrote, read, and approved the final manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the authors of this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Martin Bellgardt, MD, Academic Research, Senior Scientist, Staff Physician, Anesthesia and Intensive Care Medicine, St. Josef-Hospital, University Hospital of Ruhr-University of Bochum, Gudrunstr. 56, Bochum 44791, Germany. martin.bellgardt@rub.de
Received: March 8, 2021 Peer-review started: March 8, 2021 First decision: May 13, 2021 Revised: May 24, 2021 Accepted: August 23, 2021 Article in press: August 23, 2021 Published online: November 9, 2021 Processing time: 241 Days and 12.9 Hours
Abstract
Coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome (ARDS) is a severe complication of infection with severe acute respiratory syndrome coronavirus 2, and the primary cause of death in the current pandemic. Critically ill patients often undergo extracorporeal membrane oxygenation (ECMO) therapy as the last resort over an extended period. ECMO therapy requires sedation of the patient, which is usually achieved by intravenous administration of sedatives. The shortage of intravenous sedative drugs due to the ongoing pandemic, and attempts to improve treatment outcome for COVID-19 patients, drove the application of inhaled sedation as a promising alternative for sedation during ECMO therapy. Administration of volatile anesthetics requires an appropriate delivery. Commercially available ones are the anesthetic gas reflection systems AnaConDa® and MIRUSTM, and each should be combined with a gas scavenging system. In this review, we describe respiratory management in COVID-19 patients and the procedures for inhaled sedation during ECMO therapy of COVID-19 related ARDS. We focus particularly on the technical details of administration of volatile anesthetics. Furthermore, we describe the advantages of inhaled sedation and volatile anesthetics, and we discuss the limitations as well as the requirements for safe application in the clinical setting.
Core Tip: This article summarizes the use of inhaled sedation for extracorporeal membrane oxygenation in patients suffering from coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome, including a description of respiratory management, the technical aspects, and requirements for delivery of volatile anesthetics. The article closes with important future considerations for inhaled sedation in critically ill COVID-19 patients undergoing extracorporeal membrane oxygenation therapy.
