Evaluation of opioid requirements in mechanically ventilated patients taking buprenorphine/naloxone prior to admission

Background

With limited data quantifying opioid requirements based on substance use history, including buprenorphine/naloxone use, optimal pain management for mechanically ventilated patients remains unknown.

Objective

To compare opioid requirements in mechanically ventilated adults admitted to the intensive care unit (ICU) taking buprenorphine/naloxone prior to admission compared to those who do not.

Methods

This multicenter, retrospective study included adults admitted to a medical ICU and mechanically ventilated for at least 12 h. The primary endpoint was mean hourly opioid rate (fentanyl equivalents [FE], μg FE/h) from intubation until extubation or up to 72 h. Secondary endpoints included sedative requirements and time with pain and depth of sedation scores within goal. To adjust for confounders, a negative binomial model was performed.

Results

Of 176 patients, 47 took buprenorphine/naloxone, 69 were opioid-naïve, and 60 were opioid-tolerant. There was no difference in mean hourly opioid rate between buprenorphine/naloxone (40.8 ± 37.1 μg FE/h) and opioid-naïve (31.7 ± 32.5 μg FE/h; p = 0.17) and opioid-tolerant patients (51 ± 46 μg FE/h; p = 0.22). Multivariable regression demonstrated similar hourly rates in buprenorphine/naloxone and opioid-naïve patients, but opioid-tolerant patients had 50 % higher rates (estimated rate ratio 1.5, 95 % CI [1.01, 2.23]). Time spent with pain scores at goal was similar. Time spent with sedation scores at goal was similar between buprenorphine/naloxone and opioid-naïve patients, but was lower than opioid-tolerant patients.

Conclusion

Patients taking buprenorphine/naloxone prior to admission who are mechanically ventilated for at least 12 h may have opioid requirements similar to opioid-naïve patients and lower than opioid-tolerant patients.