Opioid Administration in Complex Ventilated Patients in a Surgical Intensive Care Unit

Introduction

Effective pain management in the surgical intensive care unit (SICU) is challenging, particularly for ventilated patients requiring neuromuscular blockade (NMB) infusions or extracorporeal membrane oxygenation (ECMO) support. While opioids are effective, they pose risks like sedation, respiratory depression, and withdrawal. Data on how NMB and ECMO influence opioid utilization patterns in ventilated SICU patients remain limited. We hypothesized that NMB and ECMO are associated with increased opioid utilization.

Materials and methods

This retrospective observational study was conducted at a single academic medical center. Data were extracted from the electronic health record and visualized using a business intelligence tool. Patients were grouped by ECMO status and then further stratified into four groups based on the combinations of ECMO and NMB. Statistical analyses included chi-square tests, t-tests, Wilcoxon rank-sum tests, and multivariable linear regression models.

Results

A total of 1550 patients were included in the study, including 23 ECMO-supported patients and 1527 non-ECMO patients. Within ECMO patients, NMB was associated with 265.1% higher opioid use (774.89 versus 212.24 MME/patient/d, P = 0.007), while non-ECMO patients with NMB had 226.5% higher opioid use (558.23 versus 170.97 MME/patient/d, P < 0.001). Among NMB patients, opioid use was similar between ECMO and non-ECMO patients (P = 0.112). Among non-NMB patients, opioid use was also similar between ECMO and non-ECMO patients (P = 0.725).

Conclusions

NMB infusions were associated with increased opioid utilization in these patients, whereas ECMO alone was not significantly associated with opioid use. These findings underscore the need for strategies to reduce excessive opioid use in this complex population.