(964) International Study of Opioid and Sedative Use in Patients With ARDS or COVID-19

Introduction: Patients with respiratory failure due to COVID-19 present with an ARDS-like syndrome and may require higher doses of analgesics and sedatives than most other mechanically ventilated (MV) ICU patients. This study aimed to determine the analgesia and sedation requirements of MV patients with ARDS or COVID-19. We hypothesized that requirements are similar between MV patients with ARDS and those with COVID-19.

Methods: We conducted an international, retrospective cohort study of MV adults (≥ 18 years) diagnosed with ARDS after Jan 1, 2019, and those positive for SARS-CoV-2 after Jan 1, 2021. Each site contributed at least 5 patients to each group. The primary outcome was the difference in cumulative analgesic and sedative doses 72-hr after initiation of MV between groups. Statistical analyses were performed using IBM SPSS Statistics version 28.0.0 (Armonk, New York) according to the level of measurement, data distribution, and assumptions. The a priori alpha was 5%.

Results: There were 152 patients enrolled with ARDS and 160 with COVID-19 from 25 hospitals; 195 patients from the United States, 67 from Canada, 41 from Saudi Arabia, and 9 from Argentina. Patients with COVID-19 were older (mean 55±15 vs 64±13 years; p< 0.001) and weighed more (mean 82±23 vs 93±24 kg; p< 0.001). Median ICU stay was similar for both groups [ARDS, 12 (IQR, 7-25) vs COVID-19, 16 (IQR, 9-24); p=0.102]. PaO2/FiO2 ratio, maximum FiO2, and PEEP did not differ significantly between groups in the first 72-hr of MV. There was no difference in type of opioid or sedative agents used between groups. Median total fentanyl [2400 (IQR, 1253-3638) vs 3450 (IQR, 1725-4800) mcg; p=0.009] and ketamine [144 (IQR, 80-353) vs 669 (IQR, 385-4415) mg; p=0.041], and mean total lorazepam (3.7±2.4 vs 12±0 mg; p=0.024), doses were higher for patients with COVID-19 on day 3 of MV, but did not for other agents. There were no group differences in opioid or sedative weaning process or protocol use, weaning initiation time, dose increases, or use of adjuvant agents or iatrogenic withdrawal protocols.

Conclusions: Total opioid and sedative doses are similar on day 3 of MV for adult ICU patients with ARDS or COVID-19, but total fentanyl, ketamine and lorazepam doses were higher for patients with COVID-19.