1/🧵 You have a COVID ICU patient on benzos who doesn’t respond to needle injection of local anesthetic do to sedatives.   What depth of sedation do you consider this? (it was a CME question just now)

2/ The answer is GENERAL ANESTHESIA, which of course makes sense. If a person is so deep that he/she doesn’t respond to getting stuck by a needle and the pain of lidocaine injection, that is general! Why am I writing about this?

3/ Anyone working in the ICU this past few years of #COVID #PANDEMIC is seeing this depth of sedation on a regular basis. We had almost gotten rid of this by 2019. Then COVID undid progress. People now think this is normal for some reason. It is NOT normal. It is not OK.

4/ In the 1990s, we did this to people all the time and though it was best practice. For the next 25 years, we all worked globally to prove this depth of sedation (RASS -5, unarousable to painful stimuli) is dangerous. It accelerates death if used in a prolonged way (days).

5/ This depth of sedation actually brings brain waves in a person’s head to a screeching halt. “BURST SUPPRESSION.” This is like a flat-line on a heart tracing. It’s not OK to do this to a person when you don’t need to. All of us are guilty of silencing the brain like this.

6/ We proved that this “putting the person’s brain on the bottom of the ocean floor” depth of sedation is an independent risk factor for increased mortality and for accelerating development of new onset dementia.

7/ COVID patients have enough to deal with in recovery, especially when so many people go on to get #LongCOVID on top of their #PICS. This is a preventable form of iatrogenic injury to a person.

8/ In addition, this depth of sedation brings on an immense amount of immobilization and subsequent muscle and nerve injury, which makes people unable to walk, do their job, and meet with loved ones. Advocate for your loved ones. Read about it here:

9/fin Every patient, every day should receive the full ABCDEF Bundle (wake her up, try stopping vent & walking her, family at bedside). We have 35 NEJM, JAMA & LANCET papers to support #A2Fbundle and >400 studies total 🟰 less death & shorter stays. Get rid of Benzos…again!

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