(912) Initial Sedation Requirements in ICU Patients on Prior-to-Admission Buprenorphine/Naloxone

Introduction: Medication-assisted treatment is a cornerstone in treating opioid use disorder. Patients on buprenorphine/naloxone (Bup/Nx) prior-to-admission (PTA) have been shown to require increased amounts of opioid and non-opioid analgesics for pain control in the perioperative setting. To our knowledge, no studies exist evaluating sedation requirements in the medical intensive care unit (MICU) patient population. The purpose of this study is to determine the sedation requirements in MICU patients that were on Bup/Nx PTA compared to opioid-naïve patients.

Methods: In this retrospective, descriptive trial, medical records of MICU patients requiring mechanical ventilation were reviewed from January 2018 to December 2022. Patient were either on PTA Bup/Nx or were opioid-naïve. The primary outcome was the total amount of fentanyl in morphine milligram equivalents (MME) in the first 72 hours of admission. Secondary outcomes included total amount of opioids (in MME) and non-opioids in the first 72 hours, daily average Richmond Agitation and Sedation Score (RASS) and Critical Care Pain Observation Tool (CPOT) Score for the first 72 hours, Bup/Nx dose at discharge, and ICU and hospital lengths of stay.

Results: Baseline characteristics were similar between the groups with the exception of the older patient population in the Bup/Nx group. Seventy patients were included in the final analysis (35 in each group). Overall, the Bup/Nx group required more sedation than the opioid naïve control group, with a statistically significantly higher amount of fentanyl in the first 24 hours (191.2 MME vs. 119.0 MME, p=0.033). Although not statistically significant, there was also more propofol, dexmedetomidine, midazolam, and ketamine use in the Bup/Nx group. CPOT and RASS percentages were higher for the Bup/Nx group compared to the control group, (CPOT score greater than three in 33.3% vs. 28.6% (p=0.245) and RASS greater than zero in 22.2% vs. 12.5% (p=0.183)).

Conclusions: This study demonstrated an increased opioid and non-opioid sedation requirement in patients taking Bup/Nx PTA as compared to the opioid-naïve control group. There was a statistically significant increase in fentanyl requirements within the first 24 hours of admission in the Bup/Nx group.