How much is too much? A medication use evaluation of VA ICU sedation practice during the COVID-19 pandemic

Sedative use and dosing increased during the first two years of COVID compared to pre-COVID, especially for COVID+ patients. The sustained elevated levels of fentanyl use in Year 2 suggests possible 'therapeutic creep' away from guideline-concordant practices for COVID+ patients. Antipsychotic prescription during intubation and following extubation was also more common among COVID + . These findings could inform development and implementation of safer sedation practices across VA ICUs during respiratory pandemics.

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Publication Details

Journal
PLoS ONE
Published
2025-12-31
DOI
https://doi.org/10.1371/journal.pone.0340225
Primary Topic
Intensive Care Unit Cognitive Disorders
Type
article
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article

How much is too much? A medication use evaluation of VA ICU sedation practice during the COVID-19 pandemic

Kathleen Morneau, Kelly Drumright, Francesca Cunningham, Kathleen M. Akgün et al.
PLoS ONE
Intensive Care Unit Cognitive Disorders
article

How much is too much? A medication use evaluation of VA ICU sedation practice during the COVID-19 pandemic

Kathleen Morneau, Kelly Drumright, Francesca Cunningham, Kathleen M. Akgün, Kenneth Bukowski, Andrew J. Franck, Muriel Burk, BreAnna Davids, Rong Jiang, Abbie Rosen, Margaret A. Pisani, PRESTON WITCHER, BROOKE KLENOSKY, LAUREN RATLIFF, SARAH PROVIDENCE, TRISHA EXLINE, ELIZABETH RIGHTNOUR, MARK WONG, ANN-MARIE SUTHERLAND, KELLY BRYAN, STACEY RICE, TRAVIS SCHMITT, Ian C. Murphy, Jennifer Lee, Tram Guilbeault, Sarah Zavala
article en

Abstract

Sedative use and dosing increased during the first two years of COVID compared to pre-COVID, especially for COVID+ patients. The sustained elevated levels of fentanyl use in Year 2 suggests possible 'therapeutic creep' away from guideline-concordant practices for COVID+ patients. Antipsychotic prescription during intubation and following extubation was also more common among COVID + . These findings could inform development and implementation of safer sedation practices across VA ICUs during respiratory pandemics.

PLoS ONEVol. 20(12)
Augusta University (US), Charlie Norwood VA Medical Center (US), Yale University (US), VA Connecticut Healthcare System (US), VA Tennessee Valley Healthcare System (US), Veterans Health Care System of the Ozarks (US), Martinsburg VA Medical Center (US), North Florida/South Georgia Veterans Health System (US), Medication Management (United States) (US), Ralph H. Johnson VA Medical Center (US), Philadelphia VA Medical Center (US), VA Pittsburgh Healthcare System (US), Jesse Brown VA Medical Center (US), South Texas Veterans Health Care System (US), VA Eastern Colorado Health Care System (US), VA Long Beach Healthcare System (US)
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Openalex Percentile: Top 31%
Intensive Care Unit Cognitive Disorders
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