Enteral Sedation in Patients Requiring Mechanical Ventilation During an Intravenous Analgesic and Sedative Shortage

• Published in: Journal of pharmacy practice 2024-06, Vol.37 (3), p.696-702
• Main Authors: Khatib, Hassan, Edwin, Stephanie B., Paxton, Renee, Hughes, Christopher, Hartner, Carrie, Al-Samman, Samer, Giuliano, Christopher
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Aged; Analgesics - administration & dosage; Analgesics - supply & distribution; Female; Fentanyl - administration & dosage; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics and Sedatives - supply & distribution; Intensive Care Units; Male; Midazolam - administration & dosage; Middle Aged; Propofol - administration & dosage; Propofol - supply & distribution; Respiration, Artificial - methods; Retrospective Studies
• ISSN: 0897-1900; 1531-1937
• DOI: 10.1177/08971900231175934

Background: There is a paucity of data evaluating the use of enteral sedation in mechanical ventilation. A sedative shortage resulted in the use of this approach. Purpose: To evaluate the feasibility of using enteral sedatives to decrease intravenous (IV) analgesia and sedative requirements. Materials/Methods: This single-center, retrospective, observational study compared two groups of patients admitted to the ICU who were mechanically ventilated. One group received a combination of enteral and IV sedatives and the second group received IV monotherapy. Linear mixed model (LMM) analyses were performed to assess the impact of enteral sedatives on IV fentanyl equivalents, IV midazolam equivalents, and propofol. Mann-Whitney U tests were performed on percent of days at goal for Richmond Agitation and Sedation Scale (RASS) and critical care pain observation tool (CPOT) scores. Results: One hundred and four patients were included. The average cohort age was 62 years and 58.7% were male. The median length of mechanical ventilation was 7.1 days and the median length of stay was 11.9 days. The LMM estimated that enteral sedatives reduced IV fentanyl equivalents received per patient by an average of 305.6 mcg/day (P = .04), although did not significantly decrease midazolam equivalents or propofol. There was no statistically significant difference in CPOT scores (P = .57 and P = .46 respectively), however RASS scores in the enteral sedation group were more often at goal (P = .03); oversedation occurred more in the non-enteral sedation group (P = .018). Conclusion: Enteral sedation may be a possible way to decrease IV analgesia requirements during periods of shortage.