Encore Presentations
Monday, October 14, 2024
01:00 PM–02:30 PM
Abstract
Introduction
Iatrogenic withdrawal syndrome (IWS) occurs with prolonged use and high doses of opioids and sedatives, and weaning through gradual dose reductions may minimize the risk of IWS. This study examined opioid and sedative weaning and IWS policies/protocols in critically ill adults receiving invasive mechanical ventilation (MV). We hypothesized that opioid and sedative weaning and IWS policies/protocols are underutilized in this population.
Methods
This was a post-hoc analysis of an international, observational, point prevalence study on a single date between June 1 and September 30, 2021. Enrollment criteria were ICU patients 18 years or older on invasive MV who received parenteral opioids or sedatives in the past 24 hours. The primary outcome was the proportion of patients who had parenteral opioids and/or sedatives weaned by an institutional policy/protocol. Parametric and nonparametric statistical analyses were performed using IBM SPSS Statistics version 28.0.0 (Armonk, New York) according to the level of measurement, data distribution, and assumptions. The a priori alpha was 5%.
Results
There were 2402 patients screened for enrollment at 87 hospitals in 229 ICUs from 11 countries, of which 1066 were enrolled. Most patients (50%) were from the US, with a mean age of 55 (SD ± 16) years. Females accounted for 38%, 50% were admitted for respiratory disease, and 37% tested PCR positive for COVID-19. The median ICU stay was 7 (IQR, 3-16) days, and 40% of patients developed ARDS. The median duration of MV was 4.6 (IQR, 1.4-11.5) days. Opioids were administered to 938 (88%), sedatives to 932 (87%), and their combination to 804 (75%) patients. Among enrolled patients, 35% were admitted to 90 ICUs with a weaning protocol, while 6% were admitted to 23 ICUs with a withdrawal protocol. By the day of data collection, 39% of patients used a weaning protocol for analgesia-sedation, while 12% used a withdrawal protocol in ICUs with such protocols.
Conclusions
Opioid and sedative weaning and IWS policies/protocols are underutilized in the ICU, as only a small proportion of patients had one implemented by the data collection day. About one-third of patients were admitted to an ICU with a weaning protocol, and about 1 in 17 to an ICU with a withdrawal protocol.
Presenting Author
Scott Bolesta PharmD, BCCCP, FCCP, FCCMWilkes University
Authors
Lisa Burry PharmD, PhD
Mount Sinai Hospital
Federico Carini MD
University of Toronto
Rebekah Eadie MPharm, MSc
Ulster Hospital
Brian Erstad PharmD
The University of Arizona College of Pharmacy
Celine Gelinas RN, PhD
McGill Uinversity
Marc Perreault PharmD, MSc
University of Montreal,
Richard Riker MD
Maine Medical Center
Kathryn Smith PharmD
Maine Medical Center