Divya Thomas, PharmD
Critical Care Pharmacy Specialist
Indiana University Health West Hospital
Avon, Indiana
Disclosure information not submitted.
Matthew Doers, MD
PGY-5 Pulmonary & Critical Care Fellow
University of Cincinnati Medical Center
Cincinnati, Pennsylvania, United States
Disclosure information not submitted.
H. Luke Ogden, MS
MD Candidate 2023
University of Cincinnati Medical Center
Cincinnati, Pennsylvania, United States
Disclosure information not submitted.
Jessica Winter, Pharm.D., BCCCP, BCPS
Clinical Pharmacy Specialist
University of Cincinnati Medical Center, United States
Disclosure information not submitted.
Muhammad Zafar, MD, MS-CTR, FCCP
Department of Internal Medicine, Division of Pulmonary, Sleep, and Critical Care Medicine
University of Cincinnati Medical Center
Cincinnati, Pennsylvania, United States
Disclosure information not submitted.
Faysal Alhasan, MD
Department of Internal Medicine
University of Cincinnati Medical Center, United States
Disclosure information not submitted.
Jason Keller, MS
Research Affiliate
University of Cincinnati Medical Center, United States
Disclosure information not submitted.
Brett Harnett, MS
Research Affiliate
University of Cincinnati Medical Center, United States
Disclosure information not submitted.
Chris Droege, PharmD, BCCCP, FCCM
UC Health/University of Cincinnati Medical Center
Cincinnati
Disclosure information not submitted.
R. Duncan Hite, MD, FCCP, FACP
Professor, Mark A. and Alice W. Brown Chair
University of Cincinnati Medical Center, United States
Disclosure information not submitted.
Title: Evaluation of Analgosedation Weaning Strategies in Critically Ill Medicine Patients
INTRODUCTION/HYPOTHESIS: Analgosedation is standard of care in management of patients on mechanical ventilation. Drug shortages before and during the COVID-19 pandemic presented unique challenges, particularly during surges. The purpose of this study was to evaluate the impact of a structured, daily huddle report on analgosedative medication use in mechanically ventilated MICU patients.
Methods: This retrospective, single-center analysis included 3 two-month epochs before (E1), during (E2) and after (E3) initiation of an interprofessional pre-round huddle. Two metrics presented included continuous infusion (CI) analgosedation and drug shortages in effort to identify opportunities for scheduled enteral or parenteral therapies to aid CI weaning. Adult patients admitted to the MICU and on CI analgosedation were included. The primary endpoint compared daily and cumulative scheduled parenteral, enteral, and CI analgosedation administered between epochs. Secondary endpoints included percent-time in goal RASS, Objective Pain Assessment Scale (OPAS), time without delirium, evaluation of drug costs, and effect on ICU outcomes between epochs.
Results: A total of 81 patients (E1: 27; E2: 23; E3: 31) were included. Mean age (E1, 65.9±15.4 vs E2, 59.7±10.3 vs E3, 56.3±12.6 years; p=0.021) and proportion COVID-positive (E1, 0 [0%] vs E2, 6 [26.1%] vs E3, 3 [9.7%]; p=0.013) were different between groups. Cumulative CI opioid requirements (E1, 719.5 (214.4-1874.5) vs E2, 641.9 (503.7-1675.9) vs E3, 430.4 (247.2-856.5) mg morphine equivalents; p=0.029) were significantly different. Time on CI fentanyl (E1, 85.9 (46.1-170.5) vs E2, 95.3 (47.2-161.7) vs E3, 41.4 (12.4-67.2) hours; p=0.003) was also decreased. Percent-time in goal OPAS, RASS, without delirium were similar between epochs. Drug cost for CI fentanyl (E1, 3842.1 [1144.9-100009.83] vs E2, 4019.7 [2607.3-8954.4] vs E3, 2208.1 [1321.7-4451.4]; p=0.023) was reduced.
Conclusions: This exploratory analysis of a structured approach in scheduling enteral and parenteral agents to wean off CI analgosedation during drug shortages may be effective. Time on, overall CI fentanyl requirements, and costs were significantly reduced while maintaining adequate analgesia and sedation. These results may introduce novel strategies to mitigate drug shortages while maintaining clinical outcomes.