755: Practices and Outcomes Associated With Buprenorphine Use in a Critically Ill Population

Vanini, Denis; Clark, Jenna; Maynard, Kaylee; Jones, R. G. Gordon; Rappaport, Stephen; Schult, Rachel F.

doi:10.1097/01.ccm.0000908752.22800.8a

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“…Of 55 respondents, 78% reported sometimes or always continuing patients on their outpatient MOUD. Buprenorphine use and associated outcomes have been described in a small cohort of 153 ICU patients; among the 49% of patients who were prescribed buprenorphine before admission, 61% continued on their home therapy within 24 hours of ICU admission (40). Another single-center study reported 44% of patients receiving buprenorphine within three months of hospital admission received buprenorphine during the ICU phase of care, compared with 68% in the post-ICU phase of care (36).…”

Section: Discussionmentioning

confidence: 99%

Variation in Use of Medications for Opioid Use Disorder in Critically Ill Patients Across the United States

Feeney,

Law,

Walkey

et al. 2024

Critical Care Medicine

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Objectives: To describe practice patterns surrounding the use of medications to treat opioid use disorder (MOUD) in critically ill patients. Design: Retrospective, multicenter, observational study using the Premier AI Healthcare Database. Setting: The study was conducted in U.S. ICUs. Patients: Adult (≥ 18 yr old) patients with a history of opioid use disorder (OUD) admitted to an ICU between 2016 and 2020. Interventions: None. Measurements and Main Results: Of 108,189 ICU patients (658 hospitals) with a history of OUD, 20,508 patients (19.0%) received MOUD. Of patients receiving MOUD, 13,745 (67.0%) received methadone, 2,950 (14.4%) received buprenorphine, and 4,227 (20.6%) received buprenorphine/naloxone. MOUD use occurred in 37.9% of patients who received invasive mechanical ventilation. The median day of MOUD initiation was hospital day 2 (interquartile range [IQR] 1–3) and the median duration of MOUD use was 4 days (IQR 2–8). MOUD use per hospital was highly variable (median 16.0%; IQR 10–24; range, 0–70.0%); admitting hospital explained 8.9% of variation in MOUD use. A primary admitting diagnosis of unintentional poisoning (aOR 0.41; 95% CI, 0.38–0.45), presence of an additional substance use disorder (aOR 0.66; 95% CI, 0.64–0.68), and factors indicating greater severity of illness were associated with reduced odds of receiving MOUD in the ICU. Conclusions: In a large multicenter, retrospective study, there was large variation in the use of MOUD among ICU patients with a history of OUD. These results inform future studies seeking to optimize the approach to MOUD use during critical illness.

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Section: Discussionmentioning

confidence: 99%