(918) Buprenorphine Microinduction vs Methadone for Opioid Weaning in Ventilated Critically Ill Patients

Introduction: Iatrogenic withdrawal syndrome (IWS) in mechanically ventilated (MV) patients can lead to prolonged days on MV and increase intensive care unit (ICU) resources. The purpose of this study is to evaluate the effectiveness of buprenorphine microinduction (BUP) on weaning patients from opioid infusions (OI) compared to methadone (MDN).

Methods: Retrospective, cohort study examined adults admitted to the ICU, on MV, and receiving an OI who had suspected IWS. Included patients were on MV and received BUP or MDN while on an OI. Exclusion criteria were status asthmaticus/epilepticus and/or neuromuscular blockade. Patients were divided into 2 groups: BUP or MDN. The primary outcome was successful weaning of the OI in 72 hours (hr) after BUP or MDN. Secondary outcomes include liberation from MV, and all OI and sedative infusions at day 7.

Results: 398 patients who received BUP or MDN were screened;135 met inclusion: BUP (30), MDN (105). Mean age 67±14; Black race (65%) and male sex (64%). More patients in the BUP group had opioid use disorder (OUD) (73% vs 20%, p< 0.001). The majority of patients in the BUP & MDN groups received fentanyl infusions (93% and 97%, respectively), and >60% received multiple drips. Significantly more patients in the BUP group received adjunctive phenobarbital (67% vs 14%, p< 0.001). More patients in the BUP group achieved the primary outcome of successful OI wean by 72hr (63% vs. 37%, p=0.025) in the BUP-mi and Meth groups, respectively. BUP was successful at weaning the OI by day 7 in 86% of patients compared to 56% with MDN, p=0.005). More BUP patients were weaned off the sedative infusion by 72hr and 7 days (48% vs 34%, p=0.196; and 73% vs 54%, p=0.091), however this was not statistically significant. Successful liberation from MV was 80% in the BUP vs. 62% in the MDN group, p=0.065. MV-free and ICU-free days at day 28 were 7±9 vs.12±10, p=0.004) and 10.7±9 vs.4.8±7 in the BUP and MDN groups (p < 0.001).

Conclusions: BUP microinduction resulted in significantly more patients being successfully liberated from their OI when compared to MDN. Additionally, use of BUP resulted in more MV-free days when compared to MDN. BUP is effective in weaning OI and is a viable option in patients who deem to be challenging, or potentially experiencing IWS.