Scientific Poster Session II - MeRIT Primer Participants (Completed Research)

2022 MeRIT Primer Participants – Completed Research
  Sunday, November 12, 2023
  12:45 PM–02:15 PM

Abstract

Introduction: Critical care clinicians are increasingly challenged to consider aspects of care unique to patients with opioid use disorder (OUD). Medications to treat opioid use disorder (MOUD: methadone, buprenorphine, and naltrexone) improve outcomes in the outpatient setting but MOUD use practices for patients admitted to the intensive care unit (ICU) are unclear.

Research Question or Hypothesis: How is MOUD being used among patients with a history of OUD admitted to US ICUs?

Study Design: Retrospective, multicenter study.

Methods: The primary outcome was the proportion of patients who received MOUD. Secondary outcomes included MOUD use while receiving invasive mechanical ventilation, hospital day of MOUD initiation, and MOUD use duration. Multivariable logistic regression was used to examine associations between patient- and hospital-level characteristics and MOUD use.

Results: Of 108,189 ICU patients (658 hospitals) with a history of OUD, 20,508 patients (19.0%) received MOUD. Of patients receiving MOUD, 13,745 (67%) received methadone, 2,950 (14.4%) received buprenorphine, and 4,227 (20.6%) received buprenorphine/naloxone. MOUD use while on invasive mechanical ventilation occurred in 37.9% of patients. The median day of MOUD initiation was hospital day 2 (IQR 1-3) and the median duration of MOUD use was 4 (IQR 2-8) days. MOUD use per hospital was highly variable (median 16%, IQR 10-24, range 0-70%); admitting hospital explained 8.9% of total variation in MOUD use. A primary admitting diagnosis of unintentional poisoning (aOR 0.41,95% CI 0.38-0.45), presence of an additional substance use disorder (aOR 0.70, 95% CI 0.67-0.72), and several factors indicating a greater severity of illness were associated with reduced odds of receiving MOUD in the ICU.

Conclusion: In a large multicenter, retrospective study, there was large variation in the use of MOUD among ICU patients with a history of OUD. These results inform future studies seeking to optimize the approach to MOUD use during critical illness.

Presenting Author

Megan Feeney PharmD, BCCCP
Boston Medical Center

Authors

Nicholas Bosch MD, MSc
Boston University Chobanian & Avedisian School of Medicine

Anica Law MD, MS
Boston University Chobanian & Avedisian School of Medicine

Allan Walkey MD, MSc
Boston University Chobanian & Avedisian School of Medicine