From the Guidelines
Management of involuntary gasping in COVID-19 patients requires prompt recognition and intervention, with a focus on optimizing oxygenation and suppressing respiratory drive. The most recent and highest quality study, 1, published in 2021, provides evidence on the impact of therapeutics on mortality in hospitalized patients with COVID-19.
Key Considerations
- Position the patient in a semi-recumbent or prone position if appropriate to optimize oxygenation, as suggested by 1.
- Administer supplemental oxygen to maintain oxygen saturation above 92-94%, using nasal cannula, face mask, or high-flow oxygen therapy as needed, in line with the recommendations of 1.
- For medication management, consider opioids such as morphine (2-4mg IV) or fentanyl (25-50mcg IV) to suppress the respiratory drive causing gasping.
- Benzodiazepines like midazolam (1-2mg IV) can be added for additional comfort.
- If gasping persists despite these measures, neuromuscular blocking agents such as rocuronium (0.6-1.2 mg/kg IV) may be necessary in intubated patients, as mentioned in 1.
Underlying Mechanism
The underlying mechanism of gasping in COVID-19 patients often relates to severe hypoxemia, inflammatory damage to respiratory centers, or as an agonal breathing pattern in end-stage disease.
Communication and Monitoring
Communication with family members about the significance of gasping and the goals of care is essential, particularly if the patient is approaching end of life, as gasping can be distressing for observers even when the patient may not be conscious of it. Ensure continuous monitoring of vital signs, especially respiratory rate and oxygen saturation, to guide treatment decisions and adjust interventions as needed. Given the lack of specific antiviral treatments recommended for COVID-19, as noted in 1, the focus remains on supportive care and management of symptoms. Overall, the management of involuntary gasping in COVID-19 patients should prioritize optimizing oxygenation, suppressing respiratory drive, and providing comfort, while also considering the underlying mechanism and communicating effectively with family members.
From the Research
Management of Involuntary Gasping in COVID-19 Patients
There is limited direct evidence on the management of involuntary gasping in patients with COVID-19. However, the provided studies offer insights into the treatment of COVID-19 patients with respiratory complications, which may be relevant to managing involuntary gasping.
- The use of remdesivir has been shown to improve outcomes in hospitalized patients with COVID-19 requiring supplemental oxygen 2.
- Dexamethasone has been found to reduce mortality and improve recovery in patients with COVID-19 who are receiving oxygen or invasive mechanical ventilation 3, 4.
- However, the use of higher dose corticosteroids in patients with COVID-19 who are hypoxic but not requiring ventilatory support has been associated with increased mortality and adverse effects 5.
Treatment Strategies
The following treatment strategies may be considered for managing involuntary gasping in COVID-19 patients:
- Remdesivir may be used to treat hospitalized patients with COVID-19 requiring supplemental oxygen 2.
- Dexamethasone may be used to reduce mortality and improve recovery in patients with COVID-19 who are receiving oxygen or invasive mechanical ventilation 3, 4.
- However, the use of higher dose corticosteroids should be approached with caution due to the potential for increased mortality and adverse effects 5.
Respiratory Support
Involuntary gasping in COVID-19 patients may require respiratory support, including: