(951) Assessment of Changes in Pain, Agitation, and Delirium Management During the COVID-19 Pandemic

Introduction: Recent studies have found an association between COVID-19 infection and deeper sedation in mechanically ventilated patients, raising concerns about the impact of the COVID-19 pandemic on pain, agitation, and delirium (PAD) management practices overall. This study aimed to assess differences in PAD management in patients without COVID-19 infection in pre- and peri-COVID-19 pandemic timeframes.

Methods: This was a single-center, retrospective, pre-post cohort analysis of mechanically ventilated adult patients without COVID-19 infection admitted to an intensive care unit. The “pre” group enrolled patients in the pre-COVID-19 pandemic timeframe from August to December 2019; the “post” group enrolled patients in the peri-pandemic timeframe from August to December 2021. All PAD data during the first 7 days of mechanical ventilation (MV) were collected. The primary outcome was duration of MV. A multivariate linear regression analysis was performed to assess the effects of the post group on duration of MV while controlling for weight, medical ICU treatment service, early deep sedation, and APACHE II score. Secondary outcomes included depth of sedation, total daily dose of sedatives and analgesics, in-hospital mortality, and hospital and ICU length of stay (LOS).

Results: There were 339 patients included in the final analysis. There was no difference in duration of MV between the pre and post groups (93 vs 78 hrs, p=0.28); this was confirmed by multivariate linear regression (p=0.42). Patients in the post group had a greater incidence of deep sedation (53% vs 58%, p< 0.01) and less frequent Richmond Agitation-Sedation Scale assessments within a 24-hour period (13 vs 12, p=0.02) within the first 48 hours of MV. There were no significant differences in total daily dose of sedatives and analgesics, in-hospital mortality, or hospital LOS between the two groups. ICU LOS was shorter in the post group (172 vs 133 hrs, p=0.01).

Conclusions: This study suggests that PAD practices including depth of sedation and frequency of RASS assessments were significantly affected by the COVID-19 pandemic in patients without COVID-19, while other outcomes including mortality and hospital LOS were not affected. Further studies are needed to understand the broader impact of the COVID-19 pandemic on PAD management practices.