Opioid administration and weaning practices in mechanically ventilated adult intensive care unit patients: A...

Opioids are commonly administered via continuous infusion in the intensive care unit (ICU) to manage pain and anxiety during mechanical ventilation, yet strategies for safe and effective weaning remain inconsistent. This study aimed to identify clinical and opioid-related factors associated with failed weaning and prolonged opioid cessation.

The purpose of this study was to examine opioid administration and weaning practices in mechanically ventilated adults, specifically analysing associations between opioid exposure, infusion duration, percentage reduction in dose, and failed weaning attempts to identify key factors influencing weaning outcomes.

A retrospective cohort study was conducted in a metropolitan general ICU in Australia. Adult patients receiving continuous opioids and mechanical ventilation for ≥24 h were included. Demographic and clinical data were extracted from medical records and the Australian and New Zealand Intensive Care Society Adult Patient Database. The primary outcome was the association between patient and opioid infusion factors with failed weaning events, defined as a ≥10% reduction from the average hourly opioid rate in the 4 h before weaning. Multivariate logistic regression, Cox proportional hazards models, and linear regression were employed.

Among the 240 patients, 75.8% experienced at least one failed opioid weaning attempt. Higher cumulative opioid exposure and prolonged infusion duration were significantly associated with weaning failure (χ² = 27.41, degrees of freedom [df] = 1, p < 0.001). A greater percentage reduction in opioid dose was also a significant predictor of failure (odds ratio: 1.0224, 95% confidence interval: 1.010-1.036, Wald χ² = 11.81, p = 0.0006). Median dose reductions during weaning ranged from 22.6%-39.3% across opioid types. No significant correlation was observed between opioid infusion rates and pain scores (β = -0.00248, t = -1.85, p = 0.065).

Failed opioid weaning was common, and high percentage reductions in continuous opioid infusion were linked to weaning failure. Findings suggest the need for structured, gradual opioid tapering strategies and standardised weaning protocols in adult ICUs.