key: cord-263753-p3evgngz authors: Magoon, Rohan title: Dexmedetomidine in COVID-19: probing promises with prudence! date: 2020-10-27 journal: Am J Emerg Med DOI: 10.1016/j.ajem.2020.10.034 sha: doc_id: 263753 cord_uid: p3evgngz nan dilatation, interstitial extravasations and vascular stasis that can have a deleterious impact on the subsequent morbidity and mortality in this vulnerable subset [4] . In addition, common risk-factors such as obesity for DEX-associated hyperthermia and COVID-related mortality, compound the situation furthermore [4] . Long-term infusions of dexmedetomidine DEX raises a concern for the withdrawal phenomenon. This can be all the more troublesome in COVID-19 cohort with descriptions accumulating on the prolonged sedation requirement in this setting [5, 6] . While the peak DEX-doses >0.8 µg/kg/hr and daily cumulative DEX-doses >12.9 µg/kg/day have been described to be associated with an elevated withdrawal incidence [7] , lack of presentation of the contextual DEXdose administered in the COVID-19 patient featured in the Stockton and Kyle-Sidell case-report, captivates attention [1] . However, withdrawal can be prevented with the meticulous use of drug or mitigated with clonidine [5] . (iii) In addition, once on invasive mechanical ventilation, a precision approach to sedation in COVID-19 patients, as epitomized by Payen et al, appears to be prudent centralising the focus on inter-individual variability and synchronizing the level of ventilator support to the subsequent target of sedation, thereby directing the subsequent choice of sedative agents, including DEX [8, 9] . The discussion highlights that proposition of novel therapies should be associated with a beckon to err on the side of caution so as to assist physicians make informed decisions and exercise appropriate vigil, very much the case in the aforementioned context as we still ardently await the results of ongoing studies such as: 'Use of Dexmedetomidine in Light to Infection' (PRODEX, NCT04350086) and 'Immunomodulatory Profile of Dexmedetomidine Dexmedetomidine and worsening hypoxemia in the setting of COVID-19: A case report Potential therapeutic value of dexmedetomidine in COVID-19 patients admitted to ICU Dexmedetomidine-associated hyperthermia: A series of 9 cases and a review of the literature Dexmedetomidine-Associated Hyperpyrexia in Three Critically Ill Patients With Coronavirus Disease Sedation, Analgesia, and Paralysis in COVID-19 Patients in the Setting of Drug Shortages COVID-19: ICU delirium management during SARS-CoV-2 pandemic Incidence of dexmedetomidine withdrawal in adult critically Ill patients: a pilot study Sedation for critically ill patients with COVID-19: Which specificities? One size does not fit all Implications of Practice Variability: Comment Pulmonary vasculature in COVID-19: mechanism to monitoring Compounded research challenges amid the COVID-19 pandemic We do not have any conflict of interest, any commercial or financial interest in this material & agree to abide by the rules of your journal regarding publication of this article.Author Roles: RM conceptualized and wrote the entire comment.