Effects of substance use on sedation requirements in critically ill patients.

Abstract

Introduction: The purpose of this study was to evaluate the effect of substance use on sedation requirements in critically ill patients to optimize dosing in this population.

Methods: This was a multicenter, retrospective, observational, institutional review board-approved, cohort study. Included individuals were aged 18 years and older, required mechanical ventilation for more than 24 hours, and had a history of substance use in the intervention group, defined as documentation of using 1 or more substances within the past year. The primary outcome was the maximum number of concurrent continuous analgesic and sedative infusions required during intubation and mechanical ventilation.

Results: The primary outcome, maximum number of concurrent continuous analgesic and sedative infusions, was significantly higher when comparing subjects with substance use to those without substance use (3 vs 2 infusions; P < 0.001). Significantly higher doses of analgesia and sedation were also required in the substance use group, including fentanyl (150 vs 100 mcg/hr; P = 0.024), dexmedetomidine (1.2 vs 1.0 mcg/kg/hr; P = 0.040), and benzodiazepines measured in lorazepam equivalents (3 vs 1.5 mg/hr; P < 0.001).

Conclusion: In mechanically ventilated subjects, a statistically significantly higher number of concurrent continuous analgesic and sedative infusions were used in the substance use group, with larger doses required to sedate subjects.