(630) Are Sedative Medications a Modifiable Risk Factor for Non-Ventilator Hospital-Acquired Pneumonia?

Introduction: Several modifiable risk factors are know for development of non-ventilator associated hospital acquired pneumonia (NV-HAP). However, there is a paucity of literature on the effects of sedative medications on this population. We study the effects of antipsychotics, opiates, and benzodiazepines on patients who developed NV-HAP.

Methods: Single-center, retrospective study from June 2020 to May 2022. NV-HAP definition: pneumonia >48hours after admission with < 48hours of mechanical ventilation prior to onset. Pneumonia defined by lung consolidation on X-Ray or CT and ICD-10 Code, reported clinical suspicion, or positive sputum cultures. Sedating medications analyzed 72hours prior to NV-HAP diagnosis across 3 classes: antipsychotics, opiates, and benzodiazepines. Primary outcomes: need for mechanical ventilation, ICU admission, 30-day readmission and mortality. Patients categorized into lower sedation group(LSG) who received 0-1, and high sedation group(HSG) who received 2+ sedating medications. Subcategory of opiate medications analyzed as milligram morphine equivalents(MME) given 24, 48 and 72hours prior to the NV-HAP. Statistical analysis: Chi square, logistical regression and Mann Whitney U test.

Results: 483 patients met inclusion criteria. Mean of 2 sedating medications was given in 72hours prior to NV-HAP. Intubations rate 52.2% in HSG compared to 35.3% in LSG(p=0.006). ICU admission 64.2% in HSG and 52.2% in LSG(p=0.008). 30-day readmission 23.4% in HSG and 13.4% in LSG(0.006). Mortality rate was lower in HSG 28%, compared to 39.8% in LSG (0.007). Regression analysis: statistically significant correlation between use of 2+ sedating medications and need for mechanical ventilation, ICU admission and 30-day readmission, however a negative correlation with death. Opiate medications alone showed MME increased at 48hours, odds of ICU transfer increased (OR=1.003,p=0.050), and death decreased(OR=0.995,p=0.0017). At 72hours, as MME increased odds of death also decreased(OR=0.996,p=0.0012).

Conclusions: Administration of 2+ sedating medications was predictive of poorer outcomes in regard to ICU admission, need for mechanical ventilation and 30-day readmission, however, was associated with lower odds of death. This was still supported when we isolated for the administration of opiates by MME.