EFFECT OF MODAFINIL ON TIME TO WEAN FROM MECHANICAL VENTILATION

Abstract

SESSION TITLE: Late Breaking Posters in Critical CareSESSION TYPE: Original Investigation PostersPRESENTED ON: 10/18/2022 01:30 pm - 02:30 pmPURPOSE: Modafinil is a wake promoting agent commonly used in sleep disorders. Sedation during mechanical ventilation in the ICU disrupts circadian rhythms and results in sleep disturbances and delirium. Wakefulness and ability to follow commands is a key component of successful extubation. This study evaluates the effect of modafinil on time to wean from mechanical intubation.METHODS: This study was a retrospective study conducted at a single urban center. Chart review was performed on 511 patients. Exclusion criteria included patients who expired, were transferred to hospice for terminal extubation or those who required tracheostomy (n=256). Sub-group analysis was done on patients intubated at least 5 days prior to initiation of weaning trials (n=81). Data was analyzed with medcalc statistical software.RESULTS: Patients who were treated with Modafinil had an overall longer time to wean from the ventilator as compared to patients who were not treated with Modafinil. Further evaluation showed patients who received Modafinil were intubated at least 5 days or more prior to initiation of the weaning process. Sub-group analysis of these patients intubated at least 5 days or more showed a decrease in mean time to wean from ventilation by 1 day (4 days with Modafinil and 5 days without Modafinil) with findings not statistically significant (p=0.673).CONCLUSIONS: Although our study showed reduction in mean number of days to wean from ventilation with Modafinil, these results were not statistically significant due to reduction in the power of the study after further exclusion of patients intubated less than 5 days during sub-group analysis. Future studies should involve a higher number of patients for increased power and assess other variables such as dosage effect of Modafinil, RASS score, GCS score, presence of other sedating medications, and reason for failure of pressure support trial.CLINICAL IMPLICATIONS: This research may serve as the basis for future studies regarding the effect of Modafinil on time to wean from ventilation. Implications include potentially decreasing time to wean from the ventilator and may serve as a strategy to decrease total time of intubation in patients by promoting wakefullness and restoring circadian rhythms. Decreasing time of intubation is beneficial to shorten ICU stay and minimize risks associated with prolonged mechanical ventilation.DISCLOSURES:No relevant relationships by AdeYinka AdeniyiNo relevant relationships by Chelsae Keeney SESSION TITLE: Late Breaking Posters in Critical Care SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Modafinil is a wake promoting agent commonly used in sleep disorders. Sedation during mechanical ventilation in the ICU disrupts circadian rhythms and results in sleep disturbances and delirium. Wakefulness and ability to follow commands is a key component of successful extubation. This study evaluates the effect of modafinil on time to wean from mechanical intubation. METHODS: This study was a retrospective study conducted at a single urban center. Chart review was performed on 511 patients. Exclusion criteria included patients who expired, were transferred to hospice for terminal extubation or those who required tracheostomy (n=256). Sub-group analysis was done on patients intubated at least 5 days prior to initiation of weaning trials (n=81). Data was analyzed with medcalc statistical software. RESULTS: Patients who were treated with Modafinil had an overall longer time to wean from the ventilator as compared to patients who were not treated with Modafinil. Further evaluation showed patients who received Modafinil were intubated at least 5 days or more prior to initiation of the weaning process. Sub-group analysis of these patients intubated at least 5 days or more showed a decrease in mean time to wean from ventilation by 1 day (4 days with Modafinil and 5 days without Modafinil) with findings not statistically significant (p=0.673). CONCLUSIONS: Although our study showed reduction in mean number of days to wean from ventilation with Modafinil, these results were not statistically significant due to reduction in the power of the study after further exclusion of patients intubated less than 5 days during sub-group analysis. Future studies should involve a higher number of patients for increased power and assess other variables such as dosage effect of Modafinil, RASS score, GCS score, presence of other sedating medications, and reason for failure of pressure support trial. CLINICAL IMPLICATIONS: This research may serve as the basis for future studies regarding the effect of Modafinil on time to wean from ventilation. Implications include potentially decreasing time to wean from the ventilator and may serve as a strategy to decrease total time of intubation in patients by promoting wakefullness and restoring circadian rhythms. Decreasing time of intubation is beneficial to shorten ICU stay and minimize risks associated with prolonged mechanical ventilation. DISCLOSURES: No relevant relationships by AdeYinka Adeniyi No relevant relationships by Chelsae Keeney