(1160) Shift and Nursing Variability in Analgosedative Use in Mechanically Ventilated Patients With ARDS

Introduction: Analgosedative agents are commonly utilized in critically ill, mechanically ventilated (MV) patients with acute respiratory distress syndrome (ARDS). Optimal sedation levels vary based on a variety of factors. Unnecessary variation in analgosedation contributes to worse outcomes. This study aims to assess the variability in analgosedation practices between shifts and among nurses caring for critically ill patients with ARDS.

Methods: This was a retrospective cohort study of adults requiring MV for ARDS pneumonia admitted to 22 hospitals within Intermountain Health between 2019 and 2021. Excluded patients were less than 18 years, pregnant, admitted for trauma, or had seizures or alcohol withdrawal during hospitalization. We analyzed the impact of shift (day vs night) and individual nurse on utilization of propofol, opioids (fentanyl mcg equivalents), benzodiazepines (BZD) (lorazepam mg equivalents), dexmedetomidine, and ketamine. A linear mixed effects model was used to evaluate the association of shift on drug utilization. A variance component model was used to test the impact of nurses on drug utilization.

Results: 1,790 patients were included, mean age was 59 years (SD 15), mean APACHE III was 86 (31), initial worst PaO2/FiO2 was 94 (IQR 85), and median ICU length of stay was 9.7 (11.8) days. Utilization of opioids (mean 32.41 fentanyl mcg equivalents vs 29.86 fentanyl mcg equivalents; P=0.05), propofol (7 mcg/kg vs 6 mcg/kg; P< 0.001), and dexmedetomidine (1.5 mcg/kg vs 1.35 mcg/kg; P=0.005) were all higher during the night shift. Individual nurse was found to significantly impact utilization of opioids, BZDs, dexmedetomidine, propofol, and ketamine (all P< 0.005).

Conclusions: Significant differences in analgosedative use exist between day and night shifts and among individual nurses. Higher doses of opioids, propofol, and dexmedetomidine were used overnight. Individual nurses had a significant impact on utilization of opioids, BZDs, ketamine, propofol, and dexmedetomidine. The present study suggests a need for standardization of analgosedative use to optimize patient care.