(1158) Influence of the COVID Era on Sedation Practices in Mechanically Ventilated Non-COVID Patients

Introduction: Recent studies have exhibited that patients diagnosed with COVID-19 (COV19) pneumonia received higher levels of sedation when compared to other patients in the ICU. Despite guideline recommendations, deep sedation practices became common for ICU patients with COV19 requiring mechanical ventilation. There are limited data exploring the COV19 pandemic's effect on sedation practices in critically ill patients without COV19. The aim of our study was to evaluate the impact of COV19 on sedation practices in non-COV19 mechanically ventilated (MV) patients.

Methods: This was a single system, multi-center, retrospective, case-control study that included non-COV19, adults requiring MV for > 24 hours admitted to an ICU between 1/2020 and 12/2022. Patients were categorized into either the “Low” or the “High” group based on the system-wide rate of ICU patients with COV19 during the month of ICU admission. The primary endpoint compared sedative utilization between the two groups. The two groups were matched based on days of MV and predicted mortality for statistical analysis.

Results: 21,013 patients met inclusion criteria with 5,646 pairs remaining after matching. The matched pairs had a predicted mortality of 30.6% and 29.6% and an equal median duration of MV, 5 days, in the Low and High groups, respectively. The High group demonstrated an increase in propofol (7.7 v. 9.1, p< 0.01) and ketamine (6.9 v. 8.4, p< 0.01) charges per patient while the utilization of fentanyl per patient decreased (4.1 v.3.9, p=0.04). There was no change in midazolam or dexmedetomidine charges per patient. When evaluating sedation charges per day of MV, there was a statistically significant increase in all five sedative agents in the High group, highlighted by an increase in propofol use (1.09 v. 1.34 charges per day, p< 0.01). There was a 10.6% increase in the number of patients receiving at least a single continuous sedative agent in the High group (65.5 v. 76.1%, p< 0.01). There was a 6.8% and 3.3% increase in patients in the High group receiving two and three drug sedative regimens, respectively.

Conclusions: Patients requiring MV without a diagnosis of COV19 received an increase in continuous sedative burden when admitted during periods of increased COV19 admissions.