Paul Juang, BCCCP, BCPS, PharmD
Professor of Pharmacy Practice
St. Louis College of Pharmacy
Saint Louis, MO
Disclosure information not submitted.
Julianne Yeary, BCCCP, PharmD
Clinical Pharmacy Specialist - Emergency Medicine
Barnes Jewish Hospital
Saint Louis, MO
Disclosure information not submitted.
Jennifer Lashinsky, BCCCP, MPH, PharmD
Pharmacist, Critical Care
Saint Luke's Boise Medical Center
Boise, Idaho
Disclosure information not submitted.
Emily Owen, BCCCP, BCPS, MS
Clinical Pharmacy Specialist
Barnes-Jewish Hospital
Saint Louis, MO
Disclosure information not submitted.
Title: Risk Factors for Opioid Requirement in the ICU and the Hospital
Introduction: Analagosedation has been recommended from recent guidelines as a first line regimen in managing pain and agitation in the ICU. Studies have not definitively examined risk factors that affect ICU and total inpatient doses of opioids. This study examines the risk factors that affect the total amount of ICU and hospital opioid requirement.
Methods: This single-center, retrospective, cohort study was conducted at a tertiary academic medical center that was approved by the local institutional review board. Data was collected from the electronic medical record for patients admitted from July 2018 to December 2018. Patients ≥18 years of age, admitted to any ICU, on mechanical ventilation, and placed on continuous fentanyl infusion were included. All hospital opioids doses were converted to morphine milligram equivalent (MME). Descriptive statistics were performed and student t-test, Fisher’s exact test, and χ-square test were conducted, where appropriate. Linear regression analysis was conducted to examine factors that affect ICU and total hospital opioid use.
Results: A total of 1147 patients were included in this study with average age of 57.5±16 years, 709 (44.7%) male, an average ICU length of stay (LOS) of 10.2±15 days, and average total hospital LOS of 18.9±23 days. Factors that resulted in increased ICU opioid use include obstructive sleep apnea, duration of mechanical ventilation, and presence of delirium (< 0.05) while factors that resulted in decreased ICU use include increased admission age, ICU LOS and opioid naive at admission (p< 0.05). Factors that resulted in increased hospital opioid use include obstructive sleep apnea, hospital LOS, and presence of delirium (< 0.05) while factors that resulted in decreased ICU use include increased admission age, opioid naive at admission, and requirement of tracheostomy (p< 0.05).
Conclusion: Obstructive sleep apnea and presence of delirium were factors associated with increased ICU and total hospital opioid use while increased admission age and being opioid naïve at admission were associated with the decreased usage.