Analgosedation: The use of Fentanyl Compared to Hydromorphone Cover

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Analgosedation: The use of Fentanyl Compared to Hydromorphone

The Journal of Critical Care Medicine

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

By: Hahnl Choi, Sara Radparvar, Samuel L. Aitken and Jerry Altshuler

Open Access

|Aug 2021

Figures & Tables

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

Baseline Characteristics and Demographics

	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^*

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

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

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

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Accepted on: Jul 6, 2021

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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:

analgosedation,

Related subjects:

Clinical medicine,

Internal medicine,

Internal medicine, other,

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.

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