Jennifer Connell
Medical Student
Vanderbilt University School of Medicine, United States
Disclosure information not submitted.
Onur Orun, MS
Biostatistician
Vanderbilt University Medical Center, United States
Disclosure information not submitted.
Rameela Raman, PhD
PhD
Vanderbilt University Medical Center, United States
Disclosure information not submitted.
Eduard Vasilevskis, MD, MPH
Associate Professor
Vanderbilt University Medical Center, United States
Disclosure information not submitted.
Christopher Hughes, MD, MS
Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Disclosure information not submitted.
Title: The Association of the Pre-Admission Drug Burden Index on Intensive Care Unit Outcomes
Introduction: Increased exposure to sedative and anticholinergic (AC) medications has been associated with worse cognition. The drug burden index (DBI) is a validated tool that evaluates exposure to sedative and AC medications. We sought to investigate the association of pre-admission DBI on duration of acute brain dysfunction, duration of mechanical ventilation, and ICU length of stay among ICU survivors.
Methods: We performed a nested cohort study of medical and surgical ICU survivors at Vanderbilt University Medical Center. Pre-admission medication lists were extracted from the electronic health record. Drug burden of any sedative or AC drug is equal to dose of the drug, divided by the minimum daily dose plus the dose of the drug. At the minimum daily dose, drug burden of any single sedative or AC drug would be 0.5. The DBI is a sum of each sedative and AC drug burden values. A score of 0 signals no exposure, < 1 low exposure, and > 1 high exposure. Acute brain dysfunction (delirium or coma) was assessed daily using RASS and CAM-ICU. Three separate proportional odds logistic regression models were fit for the outcomes of duration of acute brain dysfunction, mechanical ventilation, and ICU length of stay, adjusting for pre-specified covariates including age, sex, race, pre-existing cognitive impairment, comorbid disease, sepsis on admission, and ICU type (medical/surgical).
Results: Total of 676 ICU patients of median age 57.6 [47.8-66.6] years were included. Median pre-admission DBI was 1.97 [0.8- 3.36]. Median duration of acute brain dysfunction was 3.0 [1.0-7.0] days, median duration of mechanical ventilation 2.2 [0.9-6.1] days, and median ICU length of stay was 4.9 [2.6-10.1] days. Following logistic regression, we did not find a statistically significant association between pre-admission DBI and duration of acute brain dysfunction (OR 1.26 [0.97,1.63]), duration of mechanical ventilation (OR 1.20 [0.94,1.54], or ICU length of stay (OR 1.15 [0.89,1.47]).
Conclusions: High sedative and anticholinergic exposure was common. We did not find a significant association between pre-admission DBI and in-hospital outcomes among ICU survivors. Investigation into the impact of cumulative DBI throughout acute hospitalization and hospital discharge may prove more significant of in-hospital and long-term survivor outcomes.