Andy Kim, BCCCP, PharmD, BCCCP
Clinical Pharmacy Specialist, MICU
Denver Health
Denver
Disclosure information not submitted.
Melissa Maffei
PharmD Candidate
University of Colorado Skaggs School of Pharmacy, United States
Disclosure information not submitted.
Spencer Laehn, PharmD, BCCCP
Clinical Pharmacist, Critical Care/Emergency Medicine
Denver Health Medical Center
Denver, Colorado, Colorado, United States
Disclosure information not submitted.
Title: Risk Factors Associated with Opioid/Benzodiazepine Withdrawal Syndrome in COVID-19 ARDS
Introduction: Mechanically ventilated COVID-19 ARDS patients often receive deeper sedation and analgesia to maintain respiratory compliance and minimize staff exposure, which incurs greater risk of acute withdrawal syndrome (AWS) and has been associated with worse patient outcomes. This study aims to identify potential risk factors and differences in patient outcomes associated with the development of AWS in COVID-19 ARDS patients.
Methods: A retrospective analysis of 115 ventilated COVID-19 ARDS ICU patients at Denver Health from March 2020–May 2021 was performed. All patients received continuous IV analgesia and sedation for ≥5 days; patients were classified as AWS and non-AWS based on receipt of scheduled oral sedative/analgesic regimens after cessation of IV therapy. Potential risk factors were assessed in univariate analyses and multivariable modeling; a p-value< 0.05 was considered significant.
Results: Subjects in the AWS group (n=57) received longer durations and greater cumulative doses of IV sedatives and analgesics than the non-AWS group (n=58). In univariate analyses, each additional day of IV opioid, dexmedetomidine, and propofol was associated with an 11% increase in odds of AWS (p< .0001, p=0.002, p=0.001,respectively); each additional day of IV benzodiazepine was associated with a 10% increase in odds (p=0.001). Each 100mg increase in cumulative dose of IV lorazepam equivalents was associated with a 6% increase in odds of AWS (p=0.032). Among IV sedative/opioid types, receipt of lorazepam or hydromorphone was associated with 2.79 (p=0.01) and 2.83 (p=0.01) times higher odds of AWS, respectively. AWS patients had significantly longer hospital and ICU length of stay (LOS) and duration of mechanical ventilation (MV); each additional day of MV was associated with a 9% increase in odds of AWS (p< .0001). In the multivariable model, only hospital LOS remained significantly associated with AWS, with each additional day associated with a 7% increase in odds of AWS (p=0.02).
Conclusions: Greater cumulative doses, longer durations of sedatives/analgesia, and receipt of lorazepam or hydromorphone are associated with AWS. Each additional hospital day is associated with AWS in multivariable analysis. Limitations of this study include its observational design and lack of propensity score matching.