2000 OPEN FORUM Abstracts
THE EFFECT OF BI-LEVEL VENTILATION ON OPIOID UTILIZATION IN A MEDICAL INTENSIVE CARE UNIT
John Saul RRT, Ken Hargett RRT, Lisa Weavind MD, Andrew Shaw MD, Mechelle Williams RN ACNP-CS, Susannah Kish RN CS CCRN CPAN The University of Texas M D Anderson Cancer Center, Houston, Texas
Introduction: Opioid drugs are widely prescribed for mechanically ventilated patients in the medical intensive care unit (MICU), both for analgesia and anxiolysis. It has been suggested that the need for opioids may be related to dysynchrony and agitation while connected to the ventilator. A new mode of ventilation (BiLevel) has recently been introduced that might allow the patient to be more comfortable. The current study compared the use of opioid drugs in MICU patients before and after the introduction of the new mode.
Methods: Data relating to opioid use were collected in 25 patients (conventional group) before the introduction of Bi-Level and in 12 patients (BiLevel group) afterwards. Opioid usage was collected on day 1,2,3 and day 7 after institution of mechanical ventilation. All opioid dosages were converted to an equivalent parenteral dose of morphine sulfate for comparison. Groups were compared using chi square or Mann Whitney U tests (data sets not normally distributed).
Results: Both groups were similar in terms of age, gender, and type of malignancy. Patients in both groups had similar etiologies for their respiratory failure. Data shown in the table represent mean (SE) values.
|n||Age (years)||Gender (% male)||Malignancy (% hematologic)||Daily opioid dose (mg)|
|Pre BiLevel||25||57 (3)||56||72||247 (46)|
|Post BiLevel||12||52 (5)||67||67||147 (55)|
Conclusions: Our data suggest that BiLevel mode of ventilation may be associated with a reduced requirement for opioid drugs in critically ill cancer patients. Further studies examining the relationship of analgesia and sedation management related to ventilator mode are warranted.