Katherine Artman, PharmD, BCCCP
Clinical Pharmacist
University of Mississippi Medical Center, United States
Disclosure information not submitted.
Dakota Taylor, PharmD, BCCCP
Clinical Pharmacist
University of Mississippi Medical Center, United States
Disclosure information not submitted.
Betsy Gillenwater, BCCCP, PharmD
Critical Care Clinical Pharmacist
University of Mississippi Medical Center
Jackson, MS
Disclosure information not submitted.
Andrew Wilhelm, DO
Associate Division Director, Associate Professor
University of Mississippi Medical Center, United States
Disclosure information not submitted.
Joseph Brewer, DO
Assistant Professor
University of Mississippi Medical Center, United States
Disclosure information not submitted.
Title: Outcomes of Continuous Fentanyl versus Hydromorphone for Analgosedation in the Intensive Care Unit
Introduction: Pain management remains one of the most complex issues related to intensive care unit (ICU) management. Intravenous opioids are first line therapy for pain management in the ICU; however, it is unclear if different opioids result in improved outcomes. Recent evidence suggests that analgesia with hydromorphone in patients requiring extracorporeal membrane oxygenation could result in more delirium/coma free days and decreased opioid requirements compared to fentanyl. Due to the lack of data regarding outcomes with continuous opioid infusions in the Medical Intensive Care Units (MICU), this study evaluates clinical outcomes of patients who received continuous fentanyl versus hydromorphone infusions.
Methods: This single-center, retrospective, cohort study evaluated adult patients admitted to the MICU Service at the University of Mississippi Medical Center between January 2015, and October 2020. Patients were included if they were mechanically ventilated for at least 48 hours, received continuous infusion fentanyl or hydromorphone for at least 48 hours, and utilized the Ventilator Pain/Agitation/Delirium order set. The primary outcome assessed the total amount of opioids (measured in fentanyl equivalents [mcg]) administered during MICU stay in patients receiving fentanyl versus hydromorphone infusions. Secondary outcomes include ICU length of stay, ventilator days, time at goal sedation, and time at goal Critical Care Pain Observation Tool (CPOT).
Results: Fifty patients were included; twenty-five in each group. Median fentanyl equivalents per MICU stay in those who received hydromorphone versus fentanyl continuous infusions were 4,950 [IQR = 2,697.5 - 7,487.5] vs 6,973 mcg [IQR = 3,418.8 - 15,473.8] (p < 0.005). Average ICU length of stay was 10.2 vs 8.6 days (p = 0.41), while average ventilator days were 7.4 vs 6.6 days (p = 0.61). Average time spent at goal sedation was 123 vs 109 hours (71% vs 71%). Average time at goal CPOT was 152 vs 126 hours (85% vs 77%), (p = 0.066).
Conclusion: The use of continuous infusion hydromorphone was associated with fewer opioids administered per MICU stay. No differences were seen in ICU length of stay, ventilator days, time at goal sedation, or time at goal CPOT.