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Sedation and analgesia needs in methamphetamine intoxicated patients: much ado about nothing
Elaine Chiang1, Jon Case1, Mackenzie R Cook2
1Department of Pharmacy, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States.
Background:
Methamphetamine (M) is a widely used, powerful sympathomimetic drug that produces significant CNS stimulation. Its use is associated with psychiatric disorders, abnormal brain chemistry, and cardiovascular disease. Pre-hospital M use is associated with increased intubation, intensive care unit admission, and hospital length of stay. The purpose of this study was to determine the influence of acute M use on analgesia and sedation requirements in mechanically ventilated trauma patients.
Methods:
This single center retrospective cohort study included injured adult patients (≥16 years) admitted to the trauma intensive care unit (TICU) between 2016 and 2018 who were mechanically ventilated and had a urine drug screen (UDS) completed. The primary outcome was the median sedation and total analgesia administered during the first 48 hours of TICU admission, expressed as propofol, dexmedetomidine, lorazepam, and morphine equivalents. Secondary endpoints included the median Richmond Agitation Sedation Scale (RASS) score, median Critical Pain Observation Tool (CPOT) score, ventilator days, length of stay, in-hospital mortality, and discharge disposition.
Results:
A total of 245 patients were included in the final analysis (53 M+ and 192 M-). The patients were mostly men (78%) and sustained blunt trauma (89%) with a median age of 35 (IQR 26-52) years and median ISS of 11 (IQR 4-24). A M+ UDS was associated with increased morphine requirements, defined as greater than the cohort median of 1.91 mg/kg, during the first 12 hours of admission on the univariable analysis (OR 2.03; 95% CI, 1.07-3.82). There was no difference in median propofol (M+ 30 mcg/kg/min vs. M- 30 mcg/kg/min, p=0.58) or total morphine equivalents (M+ 5.42 mg/kg s. M- 3.89 mg/kg, p=0.30) over 48 hours between M+ and M- groups to achieve similar RASS and CPOT scores.
Conclusion:
To achieve the same level of pain control and depth of sedation, intubated TICU patients with a M+ UDS do not require more analgesia and sedation than patients with a M- UDS during the first 48 hours of admission.
Insights
Mechanically ventilated trauma patients who tested positive for methamphetamine (M+) did not require increased sedation or analgesia compared to methamphetamine-negative (M-) patients. This finding suggests similar pain management needs for both groups in the trauma intensive care unit (TICU).
Area of Science:
- Critical Care Medicine
- Trauma Surgery
- Pharmacology
Background:
- Methamphetamine (M) is a potent sympathomimetic drug with significant central nervous system (CNS) stimulant effects.
- Methamphetamine use is linked to psychiatric disorders, altered brain chemistry, and cardiovascular complications.
- Pre-hospital methamphetamine use correlates with increased need for intubation, ICU admission, and prolonged hospital stays.
Purpose of the Study:
- To investigate the impact of acute methamphetamine use on the requirements for analgesia and sedation.
- To compare sedation and analgesia needs in mechanically ventilated trauma patients with and without methamphetamine use.
Main Methods:
- A single-center, retrospective cohort study of adult trauma patients admitted to the trauma intensive care unit (TICU) between 2016 and 2018.
- Included patients were mechanically ventilated and underwent urine drug screening (UDS).
- Primary outcomes included median sedation (propofol, dexmedetomidine, lorazepam) and total analgesia (morphine) equivalents in the first 48 hours of TICU admission.
Main Results:
- Of 245 patients (53 M+, 192 M-), mostly male (78%) with blunt trauma (89%), methamphetamine-positive (M+) patients showed increased morphine requirements in the first 12 hours (OR 2.03).
- No significant difference was observed in median propofol or total morphine equivalents over 48 hours between M+ and M- groups.
- Both groups achieved similar Richmond Agitation Sedation Scale (RASS) and Critical Pain Observation Tool (CPOT) scores.
Conclusions:
- Mechanically ventilated trauma patients with a positive urine drug screen for methamphetamine (M+) do not necessitate higher doses of analgesia and sedation.
- Achieving adequate pain control and sedation depth is comparable between methamphetamine-positive and negative patients within the first 48 hours of TICU admission.
- These findings challenge assumptions about increased analgesic and sedative needs in trauma patients with acute methamphetamine intoxication.
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