Effects of substance use on sedation requirements in critically ill patients

The purpose of this study was to evaluate the effect of substance use on sedation requirements in critically ill patients to optimize dosing in this population.

This was a multicenter, retrospective, observational, institutional review board-approved, cohort study. Included individuals were aged 18 years and older, required mechanical ventilation for more than 24 hours, and had a history of substance use in the intervention group, defined as documentation of using 1 or more substances within the past year. The primary outcome was the maximum number of concurrent continuous analgesic and sedative infusions required during intubation and mechanical ventilation.

The primary outcome, maximum number of concurrent continuous analgesic and sedative infusions, was significantly higher when comparing subjects with substance use to those without substance use (3 vs 2 infusions; P < 0.001). Significantly higher doses of analgesia and sedation were also required in the substance use group, including fentanyl (150 vs 100 mcg/hr; P = 0.024), dexmedetomidine (1.2 vs 1.0 mcg/kg/hr; P = 0.040), and benzodiazepines measured in lorazepam equivalents (3 vs 1.5 mg/hr; P < 0.001).

In mechanically ventilated subjects, a statistically significantly higher number of concurrent continuous analgesic and sedative infusions were used in the substance use group, with larger doses required to sedate subjects.