Opioid Administration Practice Patterns in Patients With Acute Respiratory Failure Who Undergo Invasive Mechanical...

Area of Science:

• Critical Care Medicine
• Pharmacology
• Health Services Research

Background:

• The opioid crisis necessitates careful examination of opioid use in healthcare settings.
• Mechanical ventilation for acute respiratory failure often involves opioid administration.
• Understanding practice variations in opioid management is crucial for patient safety.

Purpose of the Study:

• To evaluate practice patterns in opioid infusion administration and dosing for patients with acute respiratory failure receiving invasive mechanical ventilation.
• To quantify inter-hospital variation in opioid use and fentanyl equivalent dosing.

Main Methods:

• Retrospective cohort study including 13,140 patients (Kaiser Permanente Northern California) and 52,033 patients (Philips electronic ICU Research Institute).
• Assessed opioid infusion administration and median daily fentanyl equivalent dose within the first 21 days of mechanical ventilation.
• Utilized hierarchical regression models to determine hospital-level variation in opioid use and dosing.

Main Results:

• Over 53% (KPNC) and 31% (eRI) of mechanically ventilated patients with acute respiratory failure received opioid infusions.
• Hospital of admission explained 7% (KPNC) and 39% (eRI) of the variation in opioid infusion use.
• Median daily fentanyl equivalent doses were 692 µg (KPNC) and 200 µg (eRI), with hospital variation noted for dosing (4% in KPNC, 20% in eRI).

Conclusions:

• Significant variation exists in opioid infusion practices for mechanically ventilated patients, indicating potential for both under and over-treatment.
• Findings support benchmarking hospital analgesia practices against risk-adjusted averages.
• Results can inform the design of clinical trials for analgesia and sedation in critical care settings.