Analgosedation: The use of Fentanyl Compared to Hydromorphone

	Fentanyl (n = 103)	Hydromorphone (n = 74)	p value
Age (years)^a	63 (53 - 70)	61.5 (50 - 71)	0.54
APACHE II^a	23 (17 - 29)	25 (19 - 29)	0.36
Location^b
MICU	52 (50.49)	31 (41.89)	0.47
SICU	39 (37.86)	35 (47.30)
CICU	12 (11.65)	8 (10.81)
Admission Diagnosis^b
Sepsis	24 (23.3)	13 (17.57)
Respiratory	21 (20.39)	23 (31.08)
GI	35 (33.98)	23 (31.08)	0.20
Metabolic	1 (0.97)	1 (1.35)
Hematologic	4 (3.88)	0 (0.00)
Cardiovascular	15 (14.56)	8 (10.81)
Other	3 (2.91)	6 (8.11)
% Male^b	67 (65.05)	40 (54.05)	0.16
Weight (kg)^a	78.20 (62.10 - 105)	70.55 (60.40 - 85)	0.17
Race
White	42 (40.78)	24 (32.43)
Black	28 (27.18)	13 (17.57)	0.12
Hispanic	23 (22.33)	21 (28.38)
Asian	6 (5.83)	9 (12.16)
Other/ Unknown	4 (3.88)	7 (9.46)
Comorbidities
Pulmonary conditions	32 (31.07)	22 (29.73)	0.87
Hypertension	57 (55.34)	42 (56.76)	0.88
Diabetes	41 (39.81)	32 (43.24)	0.76
Coronary artery disease	51 (49.51)	25 (33.78)	0.046^*
Chronic Opioid Use^b	40 (38.83)	38 (51.35)	0.13
Child Pugh^b
Class A	18 (17.48)	8 (10.81)	0.28
Class B or C	85 (82.52)	66 (89.19)
Alcohol Withdrawal	7 (6.8)	1 (1.35)	0.87
RASS Goals
0 to -2	97 (96.04)	60 (82.19)
-2 to -3	1 (0.99)	5 (6.85)	0.01^*
-3 to -4	2 (1.98)	3 (4.11)
-4 to -5	1 (0.99)	5 (6.85)
Paralysis	11 (10.68)	19 (25.68)	0.014^*

[i] Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation; CICU, cardiac intensive care unit; GI, gastrointestinal; MICU, medical intensive care unit; RASS, Richmond Agitation Sedation Scale; SICU, surgical intensive care unit; median (interquartile range). bN (%). * Indicates significant difference.

Table 2

Background Sedative Use and Doses

	Fentanyl (n = 103)	Hydromorphone (n = 74)	p value
Midazolam	47 (45.63)	30 (40.54)	0.54
Propofol^b	53 (51.46)	42 (56.76)	0.54
Dexmedetomidine	43 (41.75)	18 (24.32)	0.02*
Propofol (mg/kg/day)^a	16.17 (5.035 - 33.415)	13.52 (7.205 - 27.08)	0.67
Midazolam (mg/day)^a	33.06 (16.3375 - 44.6275)	22.76 (13.375 - 52.755)	0.43
Dexmedetomidine (mcg/kg/day)^a	7.24 (2.51 - 11.42)	5.10 (1.79 - 8.97)	0.37

[i] aMedian (interquartile range). bN (%). * Indicates significant difference

Table 3

Primary Outcomes

	Fentanyl (n = 103)	Hydromorphone (n = 74)	p value
ICU Length of Stay (days)^a	8 (4 - 15)	7 (5 - 11)	0.11
Time on Mechanical Ventilation (hours)^a	146.47 (64.55 - 279.69)	122.33 (70.27 - 204.98)	0.31

[i] Abbreviations: ICU, intensive care unit; ^aMedian (interquartile range).

Table 4

Secondary Outcomes

	Fentanyl (n = 76)	Hydromorphone (n = 47)	p value
CPOT>2, (% of time)^a	0 (0 – 0)	1.23 (0 – 5.56)	<0.001*
CAM-ICU Positive, (% of time)^a	0 (0 – 7.14)	0 (0 – 19.64)	0.82
Time Within Sedation Goal, (% of time)^a	63.16 (29.27 - 87.37)	79.69 (35.38 - 88.42)	0.43
Self-Extubation^b	6 (5.83)	9 (12.16)	0.17
Need for Restraints^b	28 (27.18)	33 (44.59)	0.02*
Tracheostomy^b	8 (7.77)	15 (20.27)	0.02*
Constipation^b	40 (38.83)	38 (51.35)	0.13

[i] Abbreviations: CPOT, critical care pain observation tool; CAM-ICU, confusion assessment method for the intensive care unit; >, greater than; %, percentage; median (interquartile range). ^bN (%). * Indicates significant difference

References

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Articles in this issue

DOI: https://doi.org/10.2478/jccm-2021-0026 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809

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Language: English

Page range: 192 - 198

Submitted on: Jul 5, 2020

Accepted on: Jul 6, 2021

Published on: Aug 5, 2021

Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

pain,

Related subjects:

Internal medicine, other,

Surgery,

Surgery, other,

Anaesthesiology,

Emergency medicine and intensive-care medicine

© 2021 Hahnl Choi, Sara Radparvar, Samuel L. Aitken, Jerry Altshuler, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 7 (2021): Issue 3 (July 2021)