862

Abstract

Introduction: Analgosedation has been suggested as the initial sedation strategy for many critically ill patients due the high incidence of agitation caused by untreated pain. Analgesia-first sedation has been associated with increased ventilator-free days and reduced ICU length of stay. In comparison to propofol, concern exists regarding the potential for accumulation with opioids. A lack of data exists comparing analgosedation with fentanyl to patients receiving propofol. Methods: This retrospective, observational study was approved by the Institutional Review Board at St. John Hospital and Medical Center, a 772-bed community teaching hospital in Detroit, Michigan. Adult patients receiving mechanical ventilation for at least 24 hours and continuous infusion fentanyl or propofol were evaluated from September 2011 – March 2013. Patients with neurologic impairment, hepatic impairment, or receiving paralytics were excluded. Patients were excluded if additional continuous infusion sedation was ordered, however, supplemental opioids and benzodiazepines were permitted on an as needed basis. Mann Whitney U and chi-square analysis were used to assess associations between groups. Results: Patient demographics were similar at baseline between patients receiving propofol (n=50) and continuous infusion fentanyl (n=50). The median dose of propofol was 18 mcg/kg/ min, with patients on fentanyl requiring a median dose of 61.2 mcg/hr. No difference in duration of mechanical ventilation (fentanyl 46 hours [34.3-96.9], propofol 46.7 hours [27.9-66.7]; p=0.19) or ICU length of stay (fentanyl 5 days [3-7.25], propofol 5 days [4-8]; p=0.42) was noted between groups. The percentage of CPOT and RASS scores at goal were similar between the groups. Interestingly, more patients receiving propofol required rescue opioids to achieve goal RASS and CPOT scores (fentanyl 34%, propofol 56%; p=0.04). The frequency of rescue benzodiazepine administration was similar between groups. No difference was noted between groups related to the incidence of ICU delirium. Conclusions: Clinicians should consider an initial analgosedation strategy with fentanyl without concern for increased duration of mechanical ventilation.