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Extracorporeal membrane oxygenation and diurnal analgosedation: A comparative retrospective study in ventilated
Christopher Remmington1, Luigi Camporota1, Cathrine A McKenzie2
1Departments of Pharmacy and Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, Westminster Bridge Road, London, SE1 7EH, UK; Institute of Pharmaceutical Sciences, School of Cancer & Pharmaceutical Sciences, Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine and Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, Strand, London WC2R 2LS, UK.
Background:
Diurnal variation of analgosedation may worsen patient outcomes. However, there is no data reporting diurnal variation in patients receiving extracorporeal membrane oxygenation (ECMO).
Objectives:
To compare diurnal variation of analgosedation doses in mechanically ventilated adult patients and those receiving ECMO.
Setting:
Five ICUs (65 beds) including an ECMO unit, with patient recruitment from July 2021 to July 2023.
Methods:
Retrospective single-centre cohort study including patients aged ≥ 16 years receiving continuous intravenous (IV) opioid (fentanyl) and/or sedative (midazolam and/or propofol), receiving mechanical ventilation with or without ECMO. We collected data on all intravenous analgosedation doses (excluding boluses) from 07:00 to 18:59 (day) or from 19:00 to 06:59 (nighttime) for 48 h.
Results:
We identified 1277 patients; of whom 166 (13.0 %) received ECMO and 1111 (87.0 %) received no ECMO. Most were male 815 (63.8 %), median (interquartile range (IQR)) age 58 (42-70) years. We found no diurnal variation of analgosedation doses in ECMO patients. However, we found higher doses of fentanyl (mean difference 1.7 µg/kg, 95 % Confidence Interval (CI): 1.0, 2.4 μg/kg, p < 0.001) and propofol (mean difference 2.3 mg/kg, 95 % CI: 1.7, 2.9 mg/kg, p < 0.001) at nighttime compared to daytime in non-ECMO patients. A higher proportion of ECMO patients received neuromuscular blocking drugs compared to non-ECMO group 120 (72.3 %) vs 138 (12.4 %); p < 0.001.
Conclusions:
We found higher doses of fentanyl and propofol IV infusion doses at nighttime in non-ECMO patients. However, we found no diurnal variation of analgosedation doses in ECMO patients, most likely due to deep sedation and use of neuromuscular blocking medicines.
Implications For Clinical Practice:
Patient factors, critical illness factors and type of ICU admission are likely contributory factors to differences in diurnal variation of analgosedation doses in ECMO and non-ECMO populations.
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