This study will establish the safety and efficacy of using stellate ganglion blocks in patients with ARDS due to COVID-19 disease.
The attending proceduralist will perform the SGB in the ICU. Nurse will provide patient
monitoring and assistance during the procedure. Standard monitors and ACLS resuscitative
equipment will be immediately available. A norepinephrine solution will be at bedside to
treat potential hypotension associated with SGB. The SGB perineural catheter will be placed
using standard sterile technique. Initial perineural bolus injection - clonidine 100 mcg,
Decadron PF 5mg, and 0.25% bupivacaine 5 ml is delivered. An OnQ perineural infusion 0.2%
bupivacaine will be initiated at 2ml/hr for 5 days. Acute pain service will discontinue
infusion and remove the catheter after 5 days.
Procedure: Stellate Ganglion Block
An injection of local anesthetic into the front of the neck. Medication used for the block include- clonidine 100 mcg, Decadron PF 5mg, and 0.25% bupivacaine 5 ml is delivered.
Inclusion Criteria:
- Any patient between the ages of 19-85 with laboratory established COVID-19 infection
(via rRT-PCR) requiring critical care in an intensive care unit.
- Signs or symptoms consistent with ARDS must be present.
- The syndrome must present acutely, PaO2/FIO2 ≤ 200 mm Hg, bilateral infiltrates on
chest radiograph or CT not due to cardiac failure, need for non-invasive or invasive
mechanical ventilation, and any cardiac dysrhythmia (excluding sinus tachycardia).
Exclusion Criteria:
- Hemodynamic instability (>2 vasopressors)
- pre-hospital diagnosis of heart failure or fluid overload
- anatomical inability to perform block
- prior sympathectomy
- patient currently enrolled in another clinical trial for COVID-19 or respiratory
distress/ARDS
- uncorrectable coagulopathy, already on ECMO, already on Nitric Oxide, pre-existing
multi-organ failure (>2 organ systems).
University of Nebraska Medical Center
Omaha, Nebraska, United States