Seth Garner, PharmD, BCCCP, (he/him/his)
Critical Care Clinical Pharmacist
Wake Forest Baptist Medical Center
Winston Salem, North Carolina
Disclosure information not submitted.
Jeff Duncan, PharmD, BCCCP
Critical Care Pharmacist
Centra Lynchburg General Hospital
Lynchburg, Virginia, United States
Disclosure information not submitted.
Amanda Keith, PharmD, BCPS
Clinical Pharmacist
Centra Lynchburg General Hospital
Lynchburg, Virginia, United States
Disclosure information not submitted.
Title: Delirium Occurrence in a Fentanyl Driven Analgosedation Protocol in the Intensive Care Unit
Purpose: The Society of Critical Care Medicine (SCCM) in the Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) guidelines recommend opioids for pain management along with either propofol or dexmedetomidine for sedation in those who require mechanical ventilation. Limited evidence exists to support analgosedation titration regimens to reduce delirium compared to sedation regimens utilizing non-titratable opioids with or without other sedative agents. The objective of the study was to determine if a titratable analgosedation protocol was associated with a lower prevalence of ICU delirium compared to a non-titratable sedation regimen.
Methods: This was a single-center, retrospective study that included ICU patients admitted July 2020 to February 2021, greater than or equal to 18 years of age, on ventilator support, and received sedation with fentanyl infusion as part of the analgosedation driven titration protocol (treatment group) or the non-titratable sedation regimen (control group). Patients who were on CIWA protocol, received other opioid infusions, or had a past medical history of mental illness were excluded. The primary outcome was the prevalence of delirium among the two sedation regimens, which was defined as a positive Confusion Assessment Method in the Intensive Care Unit (CAM-ICU) score at any point during the ICU admission. Secondary outcomes included hospital and ICU length of stay, in-hospital mortality, and adverse events experienced.
Results: A total of 419 ICU patients were screened with 81 patients included in the control group versus 65 patients included in the treatment group. Patient demographics were similar between groups. No significant difference was found in positive CAM-ICU scores [31 (38%) control group versus 37 (55%) treatment group, p= 0.47]. Secondary outcomes revealed no significant difference in mortality [p=0.28], ICU length of stay [p=0.24], hospital length of stay [p=0.40], or length of ventilation [p=0.27].
Conclusion: There was a trend towards improved CAM-ICU scores with the non-titratable fentanyl infusion sedation regimen. Further research is needed to determine the best analgosedation strategy for mechanically ventilated patients.