A pharmacy-initiated electronic handoff tool may reduce the proportion of AAP-naive ICU survivors with an AAP continued at the time of ICU transfer. The handoff tool was not associated with a significant reduction in the discharge prescribing rates of AAPs for hospital survivors, but a clinically meaningful reduction was possibly achieved due to enhanced communication enabled by this tool.
Background
The purpose of this study was to determine if mechanically-ventilated trauma patients with a positive urine drug screen (UDS) for cocaine and/or amphetamines have different opioid analgesic and sedative requirements compared to similar patients with a negative drug screen for these stimulants.
Methods
This retrospective, single-center cohort study at a tertiary care, academic medical center and level 1 trauma center in the United States, included patients admitted to an adult intensive care unit (ICU) with a diagnosis of trauma between 2009 and 2013, aged 16 years and older with a UDS documented within 24 hours of admission, and mechanically ventilated for greater than 24 hours. The primary endpoint was the daily dose of opioid received during mechanical ventilation, expressed as morphine equivalents, for patients presenting with a positive UDS for cocaine and/or amphetamines as compared to patients with a negative UDS for these stimulants. Secondary endpoints included the daily benzodiazepine dose and median infusion rates of propofol and dexmedetomidine received during mechanical ventilation, duration of mechanical ventilation, ICU and hospital length of stay and in-hospital mortality. Analgesic and sedative goals were similar for the duration of the study period and both intermittent and continuous infusions of opioids and sedatives were administered to achieve these targets, though a standardized approach was not employed. A multivariate logistic regression analysis and a propensity-adjusted model evaluated patient characteristics predictive of a higher median opioid requirement.
Results
One-hundred and fifty patients were included in the final analysis. In univariate analysis, opioid and sedative requirements were similar for patients presenting with a positive UDS for cocaine and/or amphetamines as compared to patients with a negative UDS for these stimulants. In the multivariate regression analysis, increasing age and Abbreviated Injury Scale – head and neck were associated with decreased daily opioid requirements, (OR 0.95, 95% CI 0.93–0.97) and (OR 0.71, 95% CI 0.65–0.77), respectively, while pre-injury stimulant use was not predictive of opioid requirements (OR 0.88, 95% CI 0.40–1.90). In a propensity-score adjusted model, pre-injury stimulant was similarly not predictive of opioid requirements during mechanical ventilation (OR 0.97, 95% CI 0.44–2.11).
Conclusions
For trauma patients presenting with acute, pre-injury use of cocaine and/or amphetamines, analgesic and sedative requirements are variable and may not be greater than those patients presenting with a stimulant-negative UDS to achieve desirable pain control and depth of sedation, though this observation should be interpreted cautiously in light of the wide confidence interval observed in the propensity-score adjusted model. Although unexpected, these findings indicate that empirically increasing analgesic and sedative doses based on positive UDS results for these stimulants may not be necessary.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.