985: EVALUATION OF DISCHARGE OPIOID PRESCRIBING IN MECHANICALLY VENTILATED ICU PATIENTS

Abstract

Introduction: Opioids are a core component in the multimodal approach to patient analgesia during invasive mechanical ventilation (IMV). However, the implications of opioid use during IMV on prescribing opioids on hospital discharge is unknown. Methods: We conducted a retrospective cohort study of patients requiring IMV within a tertiary academic medical intensive care unit (MICU) to characterize hospital discharge opioid prescribing patterns between opioid-naive and opioid-users. We included patients that received at least 1 dose of opioid within the first 12-hours of IMV and required IMV for at least 24 hours. Patients were characterized as opioid-naïve or opioid-users based upon opioids prescribed prior to MICU admission. The primary outcome was the percentage of patients prescribed opioids at hospital discharge. Secondary outcomes included the morphine milligram equivalents (MME) per day during IMV, delirium-free days, correlation of pain (critical care pain observation tool (CPOT)) scores and MME during IMV, duration of IMV, and length of hospital stay (LOS). Results: One hundred sixty-seven consecutive patients presenting to the MICU were included. Of these, 128 (76.6%) were opioid-naïve and 39 (23.4%) were opioid-users. Median age was 59 years and 61.7% were Caucasian. More opioid-users had cancer compared to opioid-naïve (35.9% vs 14.8%, p< 0.001). Thirty-two (25%) opioid-naïve and 27 (69.2%) opioid-users were prescribed opioids on discharge. The mean MME prescribed at discharge was higher in opioid-users, compared to opioid-naive (77.2 vs 16.4, p< 0.001). The median quantity of opioids prescribed during IMV did not differ between groups (465 MME in opioid-naïve vs. 467 MME in opioid-user, p=0.49). Median daily CPOT scores did not correlate with MME or dose titrations. There was no difference in duration of IMV or LOS between groups. Opioid-naïve patients had less delirium-free days, compared to opioid-users (0.68 vs. 1.13, p=0.003). Conclusions: Our study found 25% of opioid-naïve patients undergoing IMV were discharged from the hospital on opioids and the daily CPOT score did not correlate with MME and dose titration. It is unclear why 25% of opioid-naïve patients who underwent IMV in a MICU required opioids at hospital discharge and is an area that warrants further investigation.