Clinical Investigations

Use of sedatives, opioids, and neuromuscular blocking agents in patients with acute lung injury and acute respiratory distress syndrome*

Arroliga, Alejandro C. MD; Thompson, B Taylor MD; Ancukiewicz, Marek PhD; Gonzales, Jeffrey P. PharmD; Guntupalli, Kalpalatha K. MD; Park, Pauline K. MD; Wiedemann, Herbert P. MD; Anzueto, Antonio MD for the Acute Respiratory Distress Syndrome Network

Author Information

From Scott and White, and Texas A&M Health Science Center College of Medicine, Temple, TX (ACA); Massachusetts General Hospital and Harvard Medical School, Boston, MA (BTT, MA); University of Maryland Medical Center, Baltimore, MD (JPG); Baylor College of Medicine, Houston, TX (KKG); University of Michigan Health System, Ann Arbor, MI (PKP); Cleveland Clinic, Cleveland, OH (HPW); and the University of Texas Health Science Center and the South Texas Veterans Health Care System at San Antonio, San Antonio, TX (AA).

Supported, in part, by contracts No-1-HR 46054 through 46064 with the National Institutes of Health, National Heart, Lung, and Blood Institute ARDS Clinical Network.

Dr. Anzueto has consulted for Bayer, Pfizer, and BI. He has also received honoraria from GlaxoSmithKline, BI, and Pfizer and received grant support from GlaxoSmithKline and BI (paid to the university). The remaining authors have not disclosed any potential conflicts of interest.

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For information regarding this article, E-mail: [email protected]

Critical Care Medicine 36(4):p 1083-1088, April 2008. | DOI: 10.1097/CCM.0B013E3181653895

Abstract

Objective:

The use of sedatives, opioids, and neuromuscular blocking agents (NMBAs) may delay weaning and prolong intensive care unit length of stay. We hypothesized that in patients on higher positive end-expiratory pressure (PEEP), sedatives, opioids, and NMBAs are used in a higher proportion of patients and in higher doses and that the use of these medications is associated with prolongation of weaning and mortality.

Design:

Retrospective analysis.

Setting:

The ALVEOLI trial.

Patients:

Five hundred forty-nine patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) who were enrolled in the ALVEOLI trial.

Interventions:

We analyzed prospectively collected data regarding the impact of sedatives, opioids, and NMBAs in ALI/ARDS patients on duration of mechanical ventilation, time to weaning landmarks, and mortality.

Measurements and Main Results:

Sedatives and opioids were used in >80% of the patients in similar proportion in the two groups. The use of sedatives and opioids, but not the use of NMBAs, was associated with longer time on mechanical ventilation and an increased time to achieve a 2-hr spontaneous breathing trial (p < .0001). Sedatives were also associated with increased time to achieve unassisted breathing. NMBAs were used for a short period of time, in a higher proportion of patients in the lower PEEP group, and for a longer time (0.23 days).

Conclusions:

Sedatives and opioids use was similar in the higher and lower PEEP groups. The use of sedatives and opioids, but not NMBAs, was associated with a longer time to achieve important weaning landmarks.

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Use of sedatives, opioids, and neuromuscular blocking agents in patients with acute lung injury and acute respiratory distress syndrome*