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.
Hartley Abner, Pharm.D. Candidate
Pharmacy Student
St. Louis College of Pharmacy, United States
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: Effect of Opioid Tolerance on Fentanyl Requirements
Introduction: Analagosedation has been recommended by recent guidelines as a first-line regimen in managing pain and agitation in the ICU. The US FDA has a specific definition for determining whether patients are considered opioid tolerant. Patients who are opioid tolerant may require higher dosing of opioids during the overall hospital stay. This study examines the influence of opioid tolerance on total ICU opioid and non-opioid adjunct requirements.
Methods: This is a single-center, retrospective, cohort study conducted at a 1400 bed tertiary academic medical center that was approved by the local institutional review board. Data was collected form the electronic medical record for patients admitted to large academic medical center from July 2018 to December 2018. Patients ≥18 years of age admitted to the ICU on mechanical ventilation and placed on a continuous opioid infusion were included in the study. Patients were excluded if they were on palliative care. All ICU 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.
Results: A total of 1147 patients were included with 505 (44.0%) of the patients identified as opioid-tolerant. There was no difference in baseline characteristics in those who were defined as opioid-tolerant versus those who were not. Patients who were opioid-tolerant had numerically higher ICU total MME (2755±4930 vs. 2321±3660 mg, p=0.09), hospital total MME (3514±5851 vs. 2970±4351 mg, p=0.07) and statistically higher floor total MME (145.3±394 vs. 107.7±245 mg, p=0.049). There were no differences in ICU (9.96±15 vs. 10.4±15 days, p=0.66) and total hospital length of stay (18.3±23 vs. 19.4±23 days, p=0.45). There was no difference in the number of patients receiving adjunctive analgesic agents. There were higher 30-day readmission rates in patients who were opioid-tolerant (22.8% vs. 17.0%, p=0.0163) but not 90-day admission rates (16.2% vs. 12.8%, p=0.107).
Conclusions: Patients who were opioid-tolerant prior to admission to the ICU had numerically higher ICU and total hospital opioid requirements. Although there is no difference in ICU and hospital length of stay, patients who are opioid-tolerant had higher rates of 30-day readmission rates.