Is ICU admission associated with chronic narcotic use? a 4-year follow up of ICU survivors

Abstract

Issue Title: ESICM LIVES 2015

Yaffe et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A366 http://www.icm-experimental.com/content/3/S1/A366

POSTER PRESENTATION Open Access

Is ICU admission associated with chronic narcotic use? a 4-year follow up of ICU survivors

PB Yaffe, MB Butler, RS Green, T Witter*

From ESICM LIVES 2015Berlin, Germany. 3-7 October 2015

Introduction

Patient comfort is a priority in the Intensive Care Unit (ICU). Narcotics are used to ensure optimal comfort and to facilitate patient management, including mechanical ventilation and other interventions. Previous studies indicate that chronic pain is common for an extended period after ICU discharge [1]. However, little data is available on the use of narcotic medications before and after ICU admission. We sought to describe narcotic use in this population over a multi-year time period.

Objectives

To describe narcotic use before and after ICU admission, and to identify factors associated with chronic narcotic use up to 4 years after ICU discharge.

Methods

Retrospective review of adult ( 18 years) patients admitted to an ICU in Halifax, Canada between January 1, 2005 to December 31, 2008. The dataset was created by merging hospital databases with a provincial medication database. Data collected included age, gender, length of ICU/hospital stay, interventions and complications during admission. We defined nave, intermittent, and chronic narcotic status by abstinence, use in < 70%, or >70% of days for a given time period, respectively. We assessed narcotic use at 3 months prior to ICU admission, at discharge, and annually for up to 4 years following ICU discharge.

Statistical methods used were Welchs t-test, Wilcoxon Rank-Sum test, Fishers test, McNemars test, and logistic regression.

Results

We included 2595 patients (mean age 46 yrs, 60.4% male). Reason for ICU admission was surgical in 48.6%, medical

in 38.4% and undetermined in 13%. The population included both elective and emergent admissions.

In the 3 months prior to ICU admission, 76.9% were narcotic-nave while 16.9% used narcotics intermittently, and 6.2% chronically. We found an increase in patients in the nave category from 87.8% in the early post-ICU period to 95.6% at 48-month follow-up with a corresponding decreasing trend in intermittent (8.6% to 2.6%) and chronic (3.6% to 1.8%) narcotic usage, respectively.

On logistic regression, prolonged hospital length of stay was associated with chronic narcotic use, although this effect varied with time. Nave baseline narcotic use was associated with less chronic narcotic use, and intermittent baseline use was not associated with chronic use.

Conclusions

In our study, admission to an ICU was not associated with chronic narcotic use. Further research is required to confirm our findings in other health care environments.

Grant Acknowledgment

Support from Capital District Health Authority operating grant

Published: 1 October 2015

Reference1. Devlin JW, Roberts RJ: http://www.ncbi.nlm.nih.gov/pubmed/19576523?dopt=Abstract

Web End =Pharmacology of commonly used analgesics and http://www.ncbi.nlm.nih.gov/pubmed/19576523?dopt=Abstract

Web End =sedatives in the ICU: Benzodiazepines, propofol,and opioids. Crit Care Clin 2009, 25(3):431-49.

doi:10.1186/2197-425X-3-S1-A366Cite this article as: Yaffe et al.: Is ICU admission associated with chronic narcotic use? a 4-year follow up of ICU survivors. Intensive Care Medicine Experimental 2015 3(Suppl 1):A366.

Dalhousie University, Halifax, Canada

2015 Yaffe et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0

Web End =http:// http://creativecommons.org/licenses/by/4.0

Web End =creativecommons.org/licenses/by/4.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.