Use of sedatives, opioids, and neuromuscular blocking agents in patients with acute lung injury and acute respiratory distress syndrome.
OBJECTIVE
The use of sedatives, opioids, and neuromuscular blocking agents (NMBAs) may delay weaning and prolong intensive care unit length of stay. We hypothesized that in patients on higher positive end-expiratory pressure (PEEP), sedatives, opioids, and NMBAs are used in a higher proportion of patients and in higher doses and that the use of these medications is associated with prolongation of weaning and mortality.


METHODS
Retrospective analysis.


METHODS
The ALVEOLI trial.


METHODS
Five hundred forty-nine patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) who were enrolled in the ALVEOLI trial.


METHODS
We analyzed prospectively collected data regarding the impact of sedatives, opioids, and NMBAs in ALI/ARDS patients on duration of mechanical ventilation, time to weaning landmarks, and mortality.


RESULTS
Sedatives and opioids were used in >80% of the patients in similar proportion in the two groups. The use of sedatives and opioids, but not the use of NMBAs, was associated with longer time on mechanical ventilation and an increased time to achieve a 2-hr spontaneous breathing trial (p < .0001). Sedatives were also associated with increased time to achieve unassisted breathing. NMBAs were used for a short period of time, in a higher proportion of patients in the lower PEEP group, and for a longer time (0.23 days).


CONCLUSIONS
Sedatives and opioids use was similar in the higher and lower PEEP groups. The use of sedatives and opioids, but not NMBAs, was associated with a longer time to achieve important weaning landmarks.
Arroliga
Alejandro C
AC
Scott and White, and Texas A&M Health Science Center College of Medicine, Temple, TX, USA. aarroliga@swmail.sw.org
Thompson
B Taylor
BT
Ancukiewicz
Marek
M
Gonzales
Jeffrey P
JP
Guntupalli
Kalpalatha K
KK
Park
Pauline K
PK
Wiedemann
Herbert P
HP
Anzueto
Antonio
A
D018806:APACHE; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use*; D011175:Positive-Pressure Respiration; D016032:Randomized Controlled Trials as Topic; D012128:Respiratory Distress Syndrome / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009466:Neuromuscular Blocking Agents