(312) Management of Sedation in Mechanically Ventilated Patients With Chronic Opioid Use

Introduction: While several strategies have been proposed and utilized in clinical practice for management of pain in critically ill patients who are chronically dependent on opioids, no previous studies have been conducted to evaluate the impact of chronic opioid use on sedative requirements during mechanical ventilation. The purpose of study is to evaluate the efficacy of current sedation practices in mechanically ventilated patients with a history of opioid dependence at a large health system.

Methods: In this retrospective, observational study, patients on mechanical ventilation with documented history of opioid dependence prior to admission were compared to patients without chronic opioid use. The primary outcome was the percentage of time spent in target Richmond Agitation Sedation Scale (RASS) scores during mechanical ventilation. The secondary outcomes include incidence of delirium, duration of mechanical ventilation, ICU length of stay (LOS), total amount of sedatives administered while intubated, and average reported pain scores.

Results: A total of 32 patients were analyzed and included in the study. Baseline characteristics were similar between the two groups, except patients in the OUD group were significantly younger compared to the non-OUD group (51 vs 68 years p=0.009). There was no significant difference in percentage of time spent within sedation goal between the groups (47.5% ± 21.8 vs. 68.4% ± 16.7; p=0.548). For secondary outcomes, there was a significantly higher incidence of delirium in the OUD group (62% vs. 25%; p=0.032) as well as increased average pain scores during ICU admission (2.2 ± 2.2 vs. 0.8 ± 1.0; p=0.039). In addition, there was a higher number of patients receiving propofol (100% vs. 63%; p=0.006) and ketamine (38% vs. 0%; p=0.006) in the OUD group. Consequently, the average number of sedatives used was higher in the OUD group (3 ± 1.3 vs. 2 ± 1.4; p=0.131) although this difference was not statistically significant.

Conclusions: This small, retrospective, observational study found that light sedation was similarly achieved in mechanically ventilated patients with and without baseline OUD. However, the findings of this study suggest that patients with OUD may require additional sedative agents to achieve light sedation.