(1473) Effects of Enteral Opioids and Benzodiazepines on Continuous Sedative Infusion Requirements

Introduction: The inability to wean continuous sedative infusions in mechanically intubated patients due to agitation or withdrawal is a common challenge among critically ill patients. This may result in prolonged intubation and longer intensive care unit and hospital stays. Despite scarce data, one common strategy employed to titrate sedative infusions to discontinuation is to administer scheduled enteral opioids and/or benzodiazepines. The objective of this study was to determine if the administration of scheduled enteral opioids or benzodiazepines affected continuous sedative infusion requirements.

Methods: This study was a retrospective, single-center, single population, exploratory pilot study. Patients included received mechanical ventilation and continuous fentanyl and/or propofol infusions for at least twenty-four hours and were concomitantly administered scheduled enteral oxycodone, methadone, and/or diazepam. Patients were excluded if bedded in the neuroscience intensive care unit, treated for status epilepticus or alcohol withdrawal, or received extracorporeal membrane oxygenation, continuous paralytics, or targeted temperature management. Chart review was performed to determine time within Richmond Agitation Sedation Scale goal or modified behavioral pain score goal, and continuation of enteral opioids or benzodiazepines on discharge from the intensive care unit or hospital discharge.

Results: Administration of scheduled enteral agents was associated with decreased continuous sedative requirements at 72 and 96 hours post-administration for fentanyl (112.7 mcg/hr to 0 mcg/hr, P=0.005) and at 48, 72, and 96 hours for propofol (37.1 mcg/kg/min to 0 mcg/kg/min, P=0.003). Administration of scheduled enteral agents did not affect percentage of time in RASS goal (30% vs 50%, P=0.16) but coincided with higher modified behavioral pain scores (1.8 vs 4, P=0.02). Of the patients that transferred out of the ICU, 26.9% were continued on scheduled enteral agents. Of patients that survived to discharge, 11.1% were continued on scheduled enteral agents.

Conclusions: Scheduled enteral agents may reduce continuous sedative requirements. The use of scheduled enteral sedatives should be investigated in further studies.