• John Stockton and Cameron Kyle-Sidell.
• Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, United States of America. Electronic address: jstockton@maimonidesmed.org.
• Am J Emerg Med. 2020 Oct 1; 38 (10): 2247.e1-2247.e2.

AbstractEmergency department management of hypoxemia in the setting of COVID-19 is riddled with uncertainty. The lack of high-quality research has translated to an absence of clarity at the bedside. With disease spread outpacing treatment consensus, provider discretion has taken on a heightened role. Here, we report a case of dexmedetomidine use in the setting of worsening hypoxemia, whereby oxygenation improved and intubation was avoided. Well known pharmacologic properties of the drug, namely the lack of respiratory depression and its anti-delirium effects, as well as other possible physiologic effects, suggest potential benefit for patients being managed with a delayed intubation approach. If dexmedetomidine can improve compliance with non-invasive oxygen support (the current recommended first-line therapy) while promoting better oxygenation, it may also decrease the need for mechanical ventilation and thus improve mortality.Copyright © 2020 Elsevier Inc. All rights reserved.

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