Emily Owen, BCCCP, BCPS, MS
Clinical Pharmacy Specialist
Barnes-Jewish Hospital
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.
Paul Juang, BCCCP, BCPS, PharmD
Professor of Pharmacy Practice
St. Louis College of Pharmacy
Saint Louis, MO
Disclosure information not submitted.
Title: High versus low ICU opioid requirement in mechanically ventilated patients
Introduction: Analagosedation utilizing an opioid infusion is first line for treating pain and agitation within the ICU; however, concerns for continued opioid use after ICU discharge exist in the setting of the opioid epidemic. The aim of this study was to evaluate characteristics that differed between high ICU opioid use and low ICU opioid use and determine continued opioid use after ICU discharge.
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 Mann Whitney U test and χ-square test were conducted, where appropriate.
Results: A total of 1147 patients were included in the analysis and the median ICU opioid requirement was found to be 1431 MME. Patients were dichotomized into high opioid use (n=574) versus low opioid use (N=573) based on whether their total ICU requirement was above or below the median. Patients with low opioid use were more likely to have shorter hospital (9d vs 18d; p< 0.001) and ICU (83h vs 256h; p< 0.001) LOS and shorter mechanical ventilation duration (2d vs 7d; p< 0.001). Low users also had lower maximum fentanyl rates (100 mcg/hr vs 200 mcg/hr; p< 0.001) and shorter duration of infusion (17h vs 107h; p< 0.001). While lower users also had lower total ICU opioid use excluding fentanyl doses (50 MME vs 194 MME; p< 0.001), there was no difference seen in total floor opioid use (0 (0-75)MME vs 0 (0-114)MME; p=0.785). No difference was seen between the two groups between inpatient naloxone use (2.4% vs 3.1%; p=0.476).
Conclusion: While concerns exist about analagosedation contributing to opioid use outside of the ICU, higher fentanyl use in the ICU may not contribute to continued opioid use. Future studies should evaluate the use of opioids at discharge to evaluate if any lasting opioid dependence exists after ICU opioid exposure.