(990) Evaluation of Sedation Practices in the Intensive Care Unit Following COVID-19

Introduction: The purpose was to compare sedation at UAMS Medical Center before and after the COVID-19 pandemic, to see if the deep-sedation practices commonly used in COVID-19 patients have continued to influence how critically ill patients are sedated following the pandemic.

Methods: A retrospective chart review was performed to compare sedation practices between two groups of patients admitted to the MICU between 1/1/2020-3/31/2020, and between 1/1/2022-3/31/2022. This review utilized the EHR to collect data for adult patients within these time ranges that had an ICU stay > 24 hours. Patients were excluded if they had admission diagnoses of COVID, seizures and/or status epilepticus. Use of the following infusion medications was assessed: propofol, dexmedetomidine, fentanyl, midazolam, hydromorphone, and ketamine. The maximum infusion rates for midazolam, fentanyl, and hydromorphone were collected. The usage of paralytic push doses and paralytic infusions was also analyzed.

Results: We found we are using more benzodiazepines in the period post-COVID-19 pandemic. The percentage of patients on midazolam infusions increased with 8.1% of patients in the pre-COVID group versus 11.7% in the post-COVID group. The average max rate for patients on midazolam infusions was 6.5 mg/hr in the pre group compared to 10.5 mg/hr in the post group. A similar percentage of propofol was used between the two groups (27% vs. 27.5%), a higher percentage of fentanyl (31.4% vs. 41.8%), ketamine (0.8% vs. 3.5%), and dexmedetomidine (27.4% vs. 39.6%) was used in the post-pandemic group.
The average max rate for fentanyl infusion decreased from 256 mcg/hr in the pre group to 137 mcg/hr in the post group. There were more paralytics used in the post-pandemic group with both infusions (2.8% vs. 5.7%) and IV push doses (5.4% vs. 17.7%).

Conclusions: We identified an increase in benzodiazepine use/max infusion rate, along with higher rates of paralytic use in the ICU post-pandemic. Over sedation has been associated with longer ventilation, longer ICU stays, and poor neurologic outcomes. To minimize these risks, proper stewardship is required to maximize patient recovery. Per the PADIS guidelines and SCCM ICU Liberation bundle, current sedation practices should be focused back towards goals of adequately treating pain before sedation.