Jennifer Lashinsky, BCCCP, MPH, PharmD
Pharmacist, Critical Care
Saint Luke's Boise Medical Center
Boise, Idaho
Disclosure information not submitted.
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.
Emily Owen, BCCCP, BCPS, MS
Clinical Pharmacy Specialist
Barnes-Jewish Hospital
Saint Louis, MO
Disclosure information not submitted.
Title: Assessment of Patient Gender on Opioid Therapy Administration in the ICU Patient Population
Introduction:
Current guidelines recommend analagosedation as first-line management of pain and agitation in the ICU, but don’t address the impact of gender on response to opioid therapies. Gender differences may account for increased sensitivity to opioids, variability in drug pharmacokinetics, prescribing and patient outcomes. This study examines the influence of patient gender on opioid requirements and characterizes differences observed between the genders.
Methods:
The is a single-center, retrospective, cohort study conducted at a tertiary academic medical center that was approved by the local institutional review board. All data was collected from the electronic medical record of ICU patients on mechanical ventilation between June 2018 and December 2018. Patients 18 years of age and older receiving a continuous fentanyl infusion were included and all total opioid doses were converted to morphine milligram equivalent (MME). Importantly, opioid infusions at this institution are not dosed based on weight. 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 in this study with 709 (61.8%) patients identifying as male and 438 (38.2%) as female. Hospital and ICU length of stay and APACHE II score were similar among the two groups, however, male patients weighed significantly more than female patients (94.46+30.08kg vs. 81.06+28.74kg, p< 0.001). Male patients received a higher amount of total continuous infusion fentanyl MME (2719.32+4277.06mg vs. 2176.44+4240.81mg, p=0.0364), more total ICU opioid MME (3346.37+5101.68mg vs. 2662.30+4926.19mg, p=0.0256) and more total hospital opioid MME (3467.48+5124.84mg vs. 2791.64+4960.96mg, p=0.0283) than their female counterparts. When continuous fentanyl infusion dose was converted to weight-based dosing, there was no statistically significant difference between fentanyl dose in male versus female patients (133.72+215.86mcg vs. 128.83+285.77mcg, p=0.743).
Conclusions: In mechanically ventilated ICU patients, males received higher total doses of continuous infusion fentanyl and total opioids, but there was no difference in weight-based dosing across genders when total fentanyl doses were adjusted for patient weight.