title: Sedation practices in a cohort of critically ill patients receiving prolonged mechanical ventilation.
abstract: BACKGROUND
  The aim of this paper was to describe type and amount of sedatives, opioid analgesics and anti- psychotics administered to critically ill patients receiving prolonged mechanical ventilation and identify patient-specific factors associated with their administration.
  
  
  METHODS
  Retrospective cohort study of adult patients mechanically ventilated for ≥14 days over a two-year period.
  
  
  RESULTS
  The majority of patients (88%) received lorazepam for sedation (median 14-day dose 168 mg, IQR 25-606). Morphine (median 14-day dose 125 mg, IQR 0-850) and fentanyl (median 14-day dose 2032 mcg, IQR 175-15346) were administered with relative equal frequency. Only 48% of the cohort received anti-psychotics during the first 14 days. Age was inversely associated with cumulative dose of lorazepam equivalents (ratio 0.97; 95% CI 0.95-0.99), propofol (ratio 0.93; 95% CI 0.89-0.96), and morphine equivalents (ratio 0.97; 95% CI 0.96-0.98). Substance abuse was associated with cumulative dose of lorazepam (ratio 3.37; 95% CI 1.14-8.21) and morphine equivalents (ratio 3.09; 95% CI 1.48-6.44). Ethanol abuse was associated with >50% lower cumulative dose of morphine equivalents (ratio 0.47; 95% CI 0.25-0.87).
  
  
  CONCLUSIONS
  In critically ill patients receiving prolonged ventilation, history of substance abuse predicted a 3-fold increase in 14-day cumulative dose of sedatives and opioids used. Conversely, older age was associated with decreased use of sedatives and opioids and history of alcohol abuse was only associated with decreased opioid use. Overall, patients receiving prolonged mechanical ventilation appeared to consume high cumulative doses of sedatives and opioids, with less frequent use of antipsychotics. Accounting for patient characteristics may help identify individuals with varying sedative needs.
authors.affiliation: Department of Pharmacy, Harborview Medical Center, Seattle, WA, USA. karirv@upmc.edu
authors.forename: V
authors.initials: V
authors.lastname: Karir
authors.forename: C L
authors.initials: CL
authors.lastname: Hough
authors.forename: S
authors.initials: S
authors.lastname: Daniel
authors.forename: E
authors.initials: E
authors.lastname: Caldwell
authors.forename: M M
authors.initials: MM
authors.lastname: Treggiari
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000437:Alcoholism / Q000150:complications; D000701:Analgesics, Opioid / Q000008:administration & dosage; D014150:Antipsychotic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D016292:Procedural Sedation / Q000379:methods*; D003422:Critical Care; D016638:Critical Illness; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods*; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications
chemical_list: D000701:Analgesics, Opioid; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives