Back to Basics
Emily Owen, BCCCP, BCPS, MS
Clinical Pharmacy Specialist
Barnes-Jewish Hospital
Saint Louis, MO
No relevant financial relationship(s) to disclose
Paul Juang, BCCCP, BCPS, PharmD
Professor of Pharmacy Practice
St. Louis College of Pharmacy
Saint Louis, MO
No relevant financial relationship(s) to disclose
ICU patients on mechanical ventilation often require continuous sedation to treat discomfort from the endotracheal tube; pain from injury, surgery, or lying in bed; or agitation. SCCM's 2008 pain, agitation, and delirium guidelines recommend a pain-first sedation or analgosedation regimen with an IV opioid for continuous sedation. Most mechanically ventilated patients receive a continuous IV opioid infusion, preferably with fentanyl. Continuous-infusion 0.5- to 10-µg/kg/hr doses are titrated to either a pain goal or sedation goal. Inpatient opioid use is controlled by the clinician but outpatient use is not, resulting in an increasing number of adverse effects over the past 20 years. Since 1999, mortality from opioids has increased fivefold. In 2016, opioid-related overdoses were responsible for more than 42,000 deaths, with 40% from prescription opioids. Opioid prescribing peaked in 2012 and has since been trending down, indicating that clinicians may be more aware of their opioid-prescribing practices, yet average number of days per prescription continues to increase, despite recent studies associating long-term opioid use with prescriptions longer than three to five days. Many patients do not need the entire prescription so many of these pills go unused, allowing the potential for diversion. Despite efforts to decrease opioid prescribing in emergency and postoperative settings, few studies have evaluated the association between continuous opioid infusion in sedated ICU patients and amount of opioids required during hospitalization and at discharge. The focus on multimodal pain control has brought to light nonopioid pain control medications. This session will cover the opioid epidemic, data regarding analgosedation and opioid effects post-ICU, and nonopioid pain control options Opioids for pain management carries risks of addiction, abuse, and misuse as patients transition out of the ICU environment.
Bonus CE Session Faculty: Julianne Yeary, BCCCP, PharmD – Barnes Jewish Hospital
Bonus CE Session Faculty: Jennifer Lashinsky, BCCCP, MPH, PharmD – Saint Luke's Boise Medical Center
Bonus CE Session Faculty: Emily J. Owen, BCCCP, BCPS, MS – Barnes-Jewish Hospital