#Team-based approach to sedation management in patients with SARS CoV-2 aka COVID-19 in the medical ICU

The COVID-19 pandemic has led to a proliferation of patients developing ARDS and requiring prolonged supportive care on mechanical ventilation. As a result, patients need elevated levels of sedation, often on multiple agents for a period greater than typically seen in an ICU population. As a result of this high sedation phenomenon, patients are developing higher rates of expected complications including severe constipation, neurocognitive delay, ICU myopathy, poor sedation weaning, and high pain control requirements. These complications lead to an increased rate of mortality in a population that is already very high and decreases the rate of successful extubation and discharge

Prevalence of gastrointestinal symptoms in patients with cannabis abuse presenting to the emergency room

Introduction: Cannabis is a common recreational drug among young adults that is used to induce euphoria, promote relaxation and enhance appetite. There is a recognized correlation between cannabis abuse and cyclic episodes of nausea, vomiting, and abdominal pain (cannabinoid hyperemesis syndrome). However, the contribution of such symptoms to emergency room visits and hospital admissions is not known. Methods: A one-year, retrospective study was conducted on patients who presented to the emergency department and were later admitted at Abington Hospital-Jefferson Health with confirmed cannabis use (positive urine drug screen). Aim/Goal: Our primary outcome was to understand the prevalence of gastrointestinal symptoms in this patient population. We also studied other indices including other recreational drug use, the level of care, and comorbid psychological illnesses. Results: A total of 100 patients were included in the study, 60% were male, 30.3% were admitted with a primary diagnosis of gastrointestinal symptoms (e.g., nausea, vomiting and abdominal pain or cannabinoid hyperemesis), 26.3% with neurological symptoms (i.e., altered mental status, loss of consciousness (LOC) and/or seizures), 23.2% with trauma (i.e., fall or car accident), and 6.1% with cardiac issues. 34% of our patients had no past medical history. Over 50% had at least one psychiatric illness and 38.7% were taking at least one or more antipsychotic medications. Subgroup analysis of our population admitted with GI symptoms (n=30) revealed 47% males, 36% active smokers (vs 34% in total population), 33% admit to alcohol use (vs 40% in total), 10% positive for opiates (vs 18% in total), 6.7% positive for cocaine (vs 8% in total), and 16% are on prescribed narcotics (vs 20.2% total). 27 % of these patients were placed on GMF with tele or higher level of care such as MICU, SICU, or PCU (vs 51% total) and 13.3% received echocardiogram (vs 21.2% total). Interesting results were observed when stratifying patients based on age and type of controlled substance abuse. Marijuana, opiates, and benzodiazepines or barbiturates users were more prevalent in patients 27-36 yrs. of age, with 30%, 33%, and 50%, respectively. While, cocaine, hallucinogens, and amphetamines or methamphetamines users were more prevalent in those aged 26 yrs. or younger, with 37.5%, 100%, and 66%, respectively. Conclusion: GI symptoms represent an important presenting feature in patients with cannabis abuse likely more than any other presenting features. However, patients with predominant GI symptoms might require lower level of care and less cardiac workup. Additional studies are required to elucidate the significance of GI symptoms in this population of patients further