(394) Impact of Fentanyl Pushes Versus Infusion in Critically Ill Patients: A Retrospective Review

Introduction: With the introduction of the updated PADIS guidelines emphasizing treatment of pain first to minimize sedation, there has been an increased utilization of opioid infusions in mechanically ventilated patients. TriHealth, a multicenter healthcare system, uses a complementary approach of avoiding continuous infusions and providing as needed bolus analgosedation. The purpose of this study is to compare the impact of fentanyl continuous infusion (CI) and fentanyl intermittent intravenous doses (IVP) on medical ICU length of stay (LOS) in the mechanically ventilated patient population.

Methods: This multicenter, retrospective, cohort study included medical ICU patients from Good Samaritan and Bethesda North Hospitals between July 1st, 2021 and July 31st, 2023. Patients were divided into two groups receiving either IVP or CI fentanyl. Patients were mechanically ventilated and on sedation for at least 48 hours. The primary endpoint was ICU LOS. Secondary outcomes included hospital LOS, ICU mortality, hospital mortality, time on mechanical ventilation, cumulative sedative requirements, proportion of time in goal analgesia, sedation and time without delirium. AI was used minimally.

Results: Of 344 patients, 174 and 170 patients received either IVP or CI fentanyl, respectively. ICU LOS was significantly reduced in the IVP group compared to CI fentanyl group (8.4 vs. 6.7 days, p=0.03). ICU mortality was significantly decreased in the IVP fentanyl group (44.8% vs. 58.2%, p=0.01). Cumulative requirements of adjunct sedatives including propofol, ketamine, and dexmedetomidine were significantly reduced in the IVP fentanyl arm. Proportion of time in goal analgesia and sedation assessments were greater in the IVP arm (92% vs. 80%, p< 0.0004; 66% vs. 86% p=0.001) with no difference in rates of delirium between both strategies.

Conclusions: This is the first study to look at a conservative fentanyl analgosedation approach via intermittent push doses in medical ICU mechanically ventilated patients in relation to ICU LOS. These results suggest that an IVP fentanyl strategy may be associated with shorter ICU and hospital LOS, lower mortality rates, and less sedation-related drug use compared to using CI fentanyl. Achievement of adequate pain and sedation goals were established while reducing overall consumption.