1289: EVALUATION OF SEDATION REQUIREMENTS IN CRITICALLY ILL TRAUMA PATIENTS WITH HISTORY OF SUBSTANCE USE

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Introduction: Rates of substance use are high among critically ill trauma patients, and data regarding sedation and analgesia requirements are conflicting. The purpose of this study is to compare sedative medication requirements among mechanically ventilated trauma patients with or without a history of substance use (HOSU) within the first seven days of intensive care unit (ICU) admission. We hypothesize that patients with HOSU requires more medications to control behavior than those without HOSU. Methods: This is a retrospective cohort study included adult trauma patients if they were mechanically ventilated and receiving continuous infusion (CI) sedatives for at least 48 hours within the first 5 days of hospital admission over 12 months. Patients were excluded if they received CI neuromuscular blocking agents or targeted temperature management, were diagnosed with a traumatic brain injury, or were transferred from an outside hospital. The primary outcome was the average dose of CI sedatives compared between those with versus without a HOSU. Secondary outcomes included number of CI sedatives, opioid, benzodiazepine, and antipsychotic requirements, length of mechanical ventilation, ICU and hospital length of stay, and days spent with delirium, agitation, and deep sedation. Results: 84 patients met criteria for inclusion. Patients with a HOSU (n = 43) required higher average daily doses of propofol (30 vs 24.1 mcg/kg/min, p=0.01), lorazepam equivalents (0.99 vs 0.44 mg/day, p=0.04), IV morphine equivalents (vs 86.5 vs 36.8 mg/day, p=0.0003), and a higher number of CI sedatives (p = 0.02) compared to those without HOSU. No statistical differences were found between groups in length of mechanical ventilation, ICU or hospital length of stay, antipsychotic requirements, or rates of delirium, agitation, and deep sedation. Conclusions: Among critically ill trauma patients with a HOSU, there was an increased sedation and analgesia requirement compared to those without a HOSU. Understanding substance use history in this patient population is necessary in order to set realistic expectations for managing sedation and analgesia.