LAUSR

Introduction/Hypothesis: Patients in the intensive care unit (ICU) receiving support from a mechanical ventilator often require continuous sedation due to agitation or for comfort from various procedures or general pain associated with ICU patients. The 2018 Society of Critical Care Medicine (SCCM) Pain, Agitation, Delirium, Immobility, and Sleep guidelines recommend utilizing a pain-first sedation, or analagosedation, regimen with an intravenous (IV) opioid when selecting medications for continuous sedation. Given the current climate regarding opioid use and associated complications, it is imperative that we better understand the potential consequences of an analgosedation strategy on discharge opioid prescribing. Methods: This study was a retrospective chart review of patients admitted to the ICU of a large academic medical center initiated on fentanyl infusions for analagosedation for mechanical ventilation. Low (< 1.38 mcg/kg/hr) vs high (> 1.38 mcg/kg/hr) was defined by the median (1.38 mcg/kg/hr) weight based fentanyl infusion rate throughout the study. The primary outcome was whether low vs high weight based fentanyl infusion had an impact on discharge opioid prescription occurrence. Results: A total of 50 patients (25 per group) were reviewed with opioid naïve (no opioid on home medication list on admission) patients representing 72% in the low group vs 60% in the high group (p=0.370). Patients in the low group utilized more gabapentin as a non-opioid pain management (40% vs 16%, p=0.059) as well as lidocaine patches (48% vs 16%, p=0.015) in the low vs high group, respectively. Total duration of fentanyl infusion was shorter in the low dose group vs high dose (25 [12.1-78.1] vs 85 [30.5-216.3] hours, p=0.003). The number of patients with opioid prescription at discharge was similar between the groups (44% vs 40%, p=0.774). Conclusions: Rate of opioid discharge prescriptions did not differ whether continuous infusion fentanyl was dosed low vs high while in the ICU. However, patients in the low-dose group utilized more non-opioid pain management such as lidocaine patches and gabapentin and had a shorter duration of infusion.