High opioid dose during ventilation increases risk for opioid use after discharge
Key takeaways:
- As opioid dosage given during ventilation rose, so did the risk for opioid use after discharge.
- The risk for persistent opioid use also increased with higher doses given in critical care.
ICU patients who received a high opioid dose during mechanical ventilation faced a heightened risk for opioid use after discharge, according to data presented at Society of Critical Care Medicine’s Critical Care Congress.
In a retrospective cohort study, Justin Rucci, MD, assistant professor of pulmonary, allergy, sleep and critical care medicine at Boston University, and colleagues assessed 6,746 ICU survivors who previously had acute respiratory failure and received mechanical ventilation for at least 24 hours to evaluate how opioid dosage during the first 21 days on ventilation impacts opioid use after discharge.
Researchers divided the total cohort into three groups based on the median daily fentanyl equivalent given during days on ventilation: tercile 1 (0-67 µcg), tercile 2 (> 67-700 µcg) and tercile 3 (> 700 µcg).
Within the year following discharge, 2,942 (43.6%) survivors filled an opioid prescription, and the median daily fentanyl equivalent dose was 200 µcg.
Individuals from tercile 3 had the highest risk for filling more opioid prescriptions (HR = 1.31; 95% CI, 1.13-1.53) when compared with individuals who did not get opioids during mechanical ventilation, followed by individuals from tercile 2 (HR = 1.23; 95% CI, 1.06-1.43).
Researchers also looked at the risk for filling an opioid prescription in 30 days and persistent opioid use over 1 year based on tercile through logistic regression models adjusted for several variables (demographics; social determinants of health; Charlson comorbidities; opioid prescriptions, chronic pain or opioid-related diagnoses within the prior year; principal diagnosis; length of stay; and code status).
Aligning with the main findings, those in tercile 3 faced a higher risk for these outcomes than those who did not get opioids during mechanical ventilation.
“Given the harms of the ongoing opioid epidemic, future studies should evaluate the risks and benefits of opioid-sparing strategies during [mechanical ventilation],” Rucci and colleagues wrote.