(962) Observation of Opioid and Sedative Use in Mechanically Ventilated Adults: An ALERT-ICU Substudy

Introduction: Iatrogenic withdrawal syndrome (IWS) is associated with large doses and/or prolonged use of opioids or sedatives. This study aimed to determine current patterns of opioid and sedative use in mechanically ventilated (MV) adults that may be associated with IWS. We hypothesized that many patients would receive high doses of opioids and sedatives for prolonged periods.

Methods: This was a posthoc analysis of an international, observational, point prevalence study conducted on a single date between June 1 and September 30, 2021, for invasively MV ICU patients ≥ 18 years old. The primary outcome was the proportion of patients receiving continuous opioids or sedatives for ≥ 72-hr, which included continuous IV infusion, scheduled injections, or as-needed parenteral doses with at least half administered within 24 hours. Outcomes were compared between patients receiving opioids or sedatives < 72 and ≥ 72-hr. 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 1066 patients enrolled in 229 ICUs at 87 hospitals in 11 countries. Median ICU stay was 7 (IQR, 3-16) days; 50% were admitted for respiratory disease, 40% had ARDS, and 37% tested positive for COVID-19. The median duration of MV was 4.6 (IQR, 1.4-11.5) days. Over half of the patients received continuous opioids (59%; 556/938) or sedatives (59%; 546/932) for ≥ 72-hr, with most receiving continuous IV infusion opioids (91%) and sedatives (99%). Median 24-hr total opioid and sedative doses were significantly greater when used ≥ 72-hr except for remifentanil (p=0.119), sufentanil (p=0.251), ketamine (p=0.053), and lorazepam (p=0.070). Patients on opioids or sedatives for < 72-hr received > 50% dose reductions (55% vs. 36%; p< 0.001) when weaning occurred, while those on agents ≥ 72-hr had ≤ 20% dose reductions (31% vs. 15%; p< 0.001). Three of 8 patients assessed had IWS, all receiving opioids or sedatives ≥ 72-hr.

Conclusions: Over half of MV adult ICU patients received continuous parenteral opioids or sedatives for ≥ 72-hr at higher total doses than those receiving opioids or sedatives for < 72-hr, which may increase the risk of IWS.