Docs seek alternatives to drugs in short supply
A team of Ontario critical care doctors is rushing to test an alternative strategy for sedating severely ill COVID- 19 patients on ventilators as supplies of the drugs typically used for the task run low.
Doctors heavily rely on sedatives and paralytic drugs to immobilize patients hooked up to life- saving breathing machines. As the number of ventilated patients escalates, so, too, has use of the intravenous drugs, diminishing supply levels.
What’s more, early experiences with the coronavirus suggest the amount of drugs required to keep patients on ventilators is considerably higher, said Dr. Angela Jerath, an associate professor of medicine at the University of Toronto and a staff cardiac anesthesiologist at Sunnybrook Health Sciences Centre.
“There is no bigger problem for us right now than running out of sedatives,” she said. “And if our intensive care units are overrun with COVID patients, that could happen in a matter of weeks.”
“Inhalable anaesthetics” could provide an alternative to the highly sought after paralytics and sedatives, said Jerath, who has partnered with Dr. Marat Slessarev, an intensive care physician at London Health Sciences Centre, to test the method. The approach would see a widely available class of drugs called volatile anaesthetics — frequently used in operating rooms — vaporized by a machine and inhaled.
Vaporizers would be a new piece of equipment in intensive care units, and both Jerath and Slessarev have ordered machines from suppliers with the hope of beginning a rapid study on the method’s effectiveness.
“In the midst of this crisis we need to be pragmatic and we have a head start to try and do this in a controlled manner,” Slessarev said.
The Canadian Association of Emergency Physicians this week warned members of potential shortages of the drugs used to ventilate patients and of their responsibility for conserving them. Hospital pharmacists have been building plans to safeguard stocks as the federal government attempts to ramp up supplies.
A range of the drugs used in ventilation have been “proactively assigned” to Health Canada’s current list of Tier 3 drug shortages, which includes those that have the “greatest potential impact on Canada’s drug supply and health care system.”
Though Canada has not run out of the drugs yet, demand for them has doubled or tripled, heightening concerns that supplies won’t last if a surge of COVID-19 patients hits hospitals, said Christina Adams, chief pharmacy officer at the Canadian Society of Hospital Pharmacists.
“Putting the drugs on this list allows us to expedite the process of purchasing them and getting them into the country,” she said.