Scientific Poster Session I - Original Research

Original Research
  Saturday, November 11, 2023
  11:30 AM–01:00 PM

Abstract

Introduction: While synthetic opioids have a faster onset and shorter half-life than morphine, it remains unclear whether their use is associated with faster extubation.

Research Question or Hypothesis: Is there difference in the time to first successful extubation in adults who received continuous synthetic opioid(s) (fentanyl, remifentanil, or both) with or without morphine (SO±M) versus continuous morphine (M)?

Study Design: Prospective cohort study.

Methods: We evaluated adults admitted to a 32-bed mixed Dutch ICU between 2011-2019 who received >24h of invasive mechanical ventilation (MV) and =24 hours of continuous opioids. Patients who died prior to extubation or required =14d of MV were excluded. Successful extubation was defined as MV liberation =48h or ICU discharge without MV. A Cox proportional hazards regression model that accounted for baseline [age, medical (vs. surgical) admission, APACHE-IV, BMI, Charlson Comorbidity Index, a high-opioid use condition] and daily [opioid exposure, benzodiazepine and propofol use, severe pain (BPS=7/CPOT=5), SOFA, delirium, coma] variables was constructed.

Results: Among the 1695 patients meeting study criteria, 833 (49%) were allocated to the SO±M group (3% fentanyl only, 14% remifentanil only, 83% both) and 862 (51%) to the M group. At ICU baseline, the SO±M (vs. M) group was more likely medical (45% vs. 24%, p<0.01), to be sicker [APACHE-IV, 64(48–80) vs. 55(42–70), p<0.01], and to have a high-opioid use condition(s) (20% vs. 13%, p<0.01). The SO±M(vs. M) group had a higher daily opioid exposure [52(14–262) vs. 11(6–24) IVMEQ, p<0.01] and required more days of mechanical ventilation [5(3–8) vs. 3(2–4), p<0.01]. Administration of SO±M (vs. M) was associated with a decreased daily probability of being successfully extubated (adjusted hazard ratio=0.49, 95%CI 0.41–0.59).

Conclusion: After adjusting for baseline and time-varying covariates, we found use of SO±M (vs. M) to be associated with a 51% reduced daily likelihood of being successfully extubated compared to morphine alone. Additional research is needed to confirm these findings.

Presenting Author

Ting-Ting Wu PharmD
Taipei Municipal Wan Fang Hospital

Authors

Yun-Shiuan Lin PharmD candidate
Northeastern University

John Devlin PharmD, FCCP
Northeastern University

Arjen Slooter MD, PhD
University Medical Center (UMC) Utrecht Brain Center

Louisa Smith PhD
Northeastern university