Coronavirus: Concerns over global drug shortage prompts London, Ont., sedatives study

As the possibility of a second wave of COVID-19 in the fall raises increased concern over the potential for global drug shortages, a team out of Lawson Health Research Institute in London, Ont., is launching “the largest trial of its kind” looking into whether IV sedatives can be replaced with inhaled sedatives.

The study — co-led by Dr. Marat Slessarev with Lawson and Dr. Angela Jerath of Sunnybrook Health Sciences Centre in Toronto — focuses on outcomes related to the use of inhaled sedatives in COVID-19 patients requiring ventilation.

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“When COVID-19 patients develop severe respiratory failure and need to be ventilated, they require sedation. While IV sedatives are currently used, there is concern about global drug shortages, particularly if there’s a second wave of COVID-19 in the fall,” said Slessarev.

“Even if we have enough ventilators, we won’t be able to ventilate patients without sedatives.”

According to a release, inhaled sedatives — also called volatiles — are widely available “due to their use in operating rooms to sedate patients during surgery”, though they are not commonly used to sedate patients needing ventilation. However, researchers say “early studies suggest they could be safe and even more effective than IV sedatives.”

“Preliminary studies in non-COVID patients with severe respiratory failure suggest that inhaled sedatives can reduce lung inflammation, shorten the duration of ventilation and potentially improve survival. Inhaled sedatives could therefore reduce the pandemic’s strain on ventilator capacity while improving patient outcomes,” Slessarev added.

“Since these drugs are safe, cheap and readily available, they can easily be used to address IV sedative shortages if found effective.”

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The multi-centre clinic trial is expected to involve the recruitment of about 800 patients in Canada and the United States who will be randomized to receive either IV sedatives or inhaled sedatives. Researchers will compare patient outcomes, like survival and length of ventilation, between the two groups to determine which method of sedation is most effective.

Slassarev says that if results for the use of inhaled sedatives are promising, “this could cause a paradigm shift in the way we sedate patients in intensive care units (ICUs) around the world.”

The trial also involves a sub-study looking at cognitive outcomes after treatment to see if one method of sedation yields better results.

The trial is being funded through Ontario’s COVID-19 Rapid Research Fund with additional funding from the Canadian Institutes of Health Research (CIHR), London Health Sciences Foundation and Sunnybrook Health Sciences Centre.

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