Daiki Morikawa1, Ayu Minoura1, Goji Shimizu1, Nobuhiko Shimozawa1, Kenichirou Morisawa1, Toru Yoshida1, Lonny Ashworth2 and Shigeki Fujitani1*
1Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Japan 2Department of Respiratory Care, Boise State University, USAFulltext PDF
Background: COVID-19 infection can develop into Acute Respiratory Distress Syndrome (ARDS). When using low tidal volume strategy, patients with COVID-19 ARDS have demonstrated a strong inspiratory effort. Morphine sulfate (morphine) is an effective and safe therapy for severe dyspnea in advanced lung disease. It is unclear whether morphine is effective for the acute phase of critically ill COVID-19 ARDS patients. We used continuous intravenous morphine for severe COVID-19 ARDS patients to ameliorate breathing effort and facilitate withdrawal of ventilator support. Case Presentation: Case A: A 63-year-old male was admitted and COVID-19 Polymerase Chain Reaction (PCR) was positive. His respiratory status worsened leading to moderate ARDS, prompting oral intubation. Deterioration of his respiratory status necessitated the need for Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO). Case B: A 54-year-old male was admitted and COVID-19 PCR was positive. His respiratory status worsened leading to ARDS, necessitating oral intubation. In both cases, we were unable to normalize a strong inspiratory effort despite increasing dosage of fentanyl, midazolam and propofol. We switched from these analgesics and sedative agents to morphine, leading to a reduction in the inspiratory effort. In both cases, respiratory status improved slowly. Conclusion: Continuous intravenous morphine has the possibility of suppressing extreme inspiratory effort in ventilated COVID-19 ARDS patients, while still maintaining consciousness. This may prevent patient self-inflicted lung injury, which may be caused by high driving pressure. The pharmacologic benefits of morphine use for patients with a strong inspiratory effort from acute respiratory failure in COVID-19 ARDS patients should be considered.
Morikawa D, Minoura A, Shimizu G, Shimozawa N, Morisawa K, Yoshida T, et al. Two Severe COVID-19 Cases of Successful Withdrawal from Mechanical Ventilatory Support Using Continuous Intravenous Morphine Sulfate. Ann Clin Case Rep. 2021; 6: 1906..