(972) Sedation Practices in the Surgical ICU After COVID-19 Management

Introduction: Patients with coronavirus disease 19 (COVID-19) have been described to need deeper levels of sedation using higher than recommended doses of sedatives and opioids. A hospital-wide COVID-19 sedation protocol was developed that deviated from sedation practices in the Surgical ICU (SICU). In March 2022, rates of hospitalizations from COVID-19 (Omicron variant) pneumonia nadired and these patients were no longer admitted to the SICU. The objective of this study was to determine if sedation practices changed in mechanically ventilated (MV) patients without COVID-19 in the Surgical ICU after the pandemic waned.

Methods: An IRB-approved, retrospective chart review was conducted involving adult patients who were discharged between March 2022 and May 2022 (group 1) and March 2023 and May 2023 (group 2). All patients evaluated required MV while in the SICU, received a continuous infusion sedative and/or opioid, and did not have pneumonia from COVID-19. Patients who were chemically paralyzed, comfort care status, or experienced a cardiac arrest, withdrawal syndromes, or seizures were excluded. Data is presented as median (interquartile range [IQR]). Wilcoxon Rank Sum test was used for two group comparisons. A p< 0.05 was considered significant.

Results: A total of 124 patients were included with 88% receiving fentanyl, 92% receiving propofol, and 51% receiving dexmedetomidine (DEX) as continuous infusions. There was no difference in the duration of fentanyl [12.1 (8.0, 26.1) vs 11.3 (6.8, 17.6) h, p=0.6], propofol [8.0 (3.5, 14.1) vs 6.8 (2.6, 12.0) h, p=0.3], or DEX [4.4 (2.2, 21.1) vs 3.6 (1.8, 7.4) h, p=0.3] between groups 1 and 2, respectively. There was also no difference in the total requirements of fentanyl [0.81 (0.38, 3.56) vs 0.77 (0.37, 1.45) mg, p=0.55], propofol [1457 (847, 3120) vs 1083 (544, 2237) mg, p=0.19], or DEX [0.19 (0.04, 0.54) vs 0.09 (0.05, 0.31) mg, p=0.57] between groups 1 and 2, respectively. The duration of MV [26 (18, 45) vs 21 (16 vs 35) h, p=0.1] and SICU length of stay [3.9 (2.9, 5.7) vs 3.9 (2.4, 5.8) days, p=0.6] was also similar.

Conclusions: Median sedative and fentanyl use did not change between the two time periods. The recent use of a sedation protocol for COVID-19 pneumonia did not lead to changes in practice in the SICU.