(1257) Opioid Shortage Impact on Critically Ill Patients

Introduction: The Society of Critical Care Medicine supports the use of an analgesia first strategy to reach sedation goals in critically ill patients. This data is extrapolated from the surgical ICU patient population. During a national shortage, prescribers were encouraged to use alternatives to opioid infusions to limit use. There is limited data using opioid based sedation strategies in the medical intensive care patients. This study evaluated the impact of the opioid shortage interventions on continuous opioid use, and short term outcomes in the medical ICU patient population.

Methods: Retrospective review in a tertiary, teaching institution, comparing analgosedation change in use practices in adult mechanically ventilated medical ICU patients. Out of 308 patients, 38 patients admitted prior to the opioid shortage intervention were included and 52 patients from a similar time period after the opioid shortage intervention were included.

Results: The mean opioid infusion duration was significantly shorter in the post intervention group (3.3 +3.2 days), compared to pre-intervention group (5.4 +4.2 days) (p=0.0496).The mean maximum fentanyl infusion rate was statistically different, 250.5 (+94.1) mcg/hr compared to 153.4 (+90.1) mcg/hr in post intervention group (p= 0.004). Patient exposure to continuous opioids and benzodiazepines in the post intervention group was 42% and 29%, respectively, compared to 82% and 42%, respectively in pre intervention. Hospital length of stay, ICU length of stay, and mechanical ventilation days did not differ statistically.

Conclusions: Interventions to limit opioid infusions due to shortage led to statistically significant differences in opioid infusion rates and opioid infusion days between the two groups. Days of mechanical ventilation and ICU length of stay did not differ between the two groups. The change in use pattern did not impact short-term outcomes in medical ICU patients. These observations could drive opioid infusion practices, including decreased duration and maximum doses of fentanyl infusions for mechanically ventilated patients in the medical ICU.