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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2012 July;78(7):801-9
Sedation practices in a cohort of critically ill patients receiving prolonged mechanical ventilation
Karir V. 1, Hough C. L. 2, Daniel S. 3, Caldwell E. 2, Treggiari M. M. 2, 4 ✉
1 Department of Pharmacy (VK), Harborview Medical Center, Seattle, WA, USA;
2 Division of Pulmonary and Critical Care Medicine, Department of Medicine (CLH, EC, MMT), Harborview Medical Center, Seattle, WA, USA;
3 Department of Biostatistics (SD), School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA;
4 Department of Anesthesiology and Pain Medicine (MMT), Harborview Medical Center, Seattle, WA, USA; *For the ProVent Investigators
BACKGROUND: The aim of this paper was to describe type and amount of sedatives, opioid analgesics and anti- psychotics administered to critically ill patients receiving prolonged mechanical ventilation and identify patient-specific factors associated with their administration.
METHODS: Retrospective cohort study of adult patients mechanically ventilated for ≥14 days over a two-year period.
RESULTS: The majority of patients (88%) received lorazepam for sedation (median 14-day dose 168 mg, IQR 25-606). Morphine (median 14-day dose 125 mg, IQR 0-850) and fentanyl (median 14-day dose 2032 mcg, IQR 175-15346) were administered with relative equal frequency. Only 48% of the cohort received anti-psychotics during the first 14 days. Age was inversely associated with cumulative dose of lorazepam equivalents (ratio 0.97; 95% CI 0.95-0.99), propofol (ratio 0.93; 95% CI 0.89-0.96), and morphine equivalents (ratio 0.97; 95% CI 0.96-0.98). Substance abuse was associated with cumulative dose of lorazepam (ratio 3.37; 95% CI 1.14-8.21) and morphine equivalents (ratio 3.09; 95% CI 1.48-6.44). Ethanol abuse was associated with >50% lower cumulative dose of morphine equivalents (ratio 0.47; 95% CI 0.25-0.87).
CONCLUSION: In critically ill patients receiving prolonged ventilation, history of substance abuse predicted a 3-fold increase in 14-day cumulative dose of sedatives and opioids used. Conversely, older age was associated with decreased use of sedatives and opioids and history of alcohol abuse was only associated with decreased opioid use. Overall, patients receiving prolonged mechanical ventilation appeared to consume high cumulative doses of sedatives and opioids, with less frequent use of antipsychotics. Accounting for patient characteristics may help identify individuals with varying sedative needs.