121: Sedation and Analgesia Variation in COVID-19

INTRODUCTION: Ventilator dependence in the setting of coronavirus disease 2019 (COVID-19) has presented pharmacotherapy management challenges for health systems although the degree of relative differences in sedation and analgesia requirements has yet to be quantified We report variances in sedative and analgesia exposure as well as utilization of novel and alternative sedatives and analgesics for the management of COVID-19 in the setting of drug shortages METHODS: This was a single-center observational study of consecutive mechanically ventilated (MV) adult patients who were hospitalized between May 1, 2019 and April 30, 2020 Patients with a laboratory-confirmed diagnosis of COVID-19 (C-19P) and patients without a laboratory-confirmed diagnosis of COVID-19 (C-19N) were identified Daily mean sedative and analgesia exposure between C-19P and C-19N cohorts were evaluated Analgesia exposure was defined as mean morphine equivalents in mg (MME) Descriptive statistics included mean and standard deviation calculations for normally-distributed data and median and interquartile range calculations for nonparametric data, and percentages as appropriate Log transformed MV duration was evaluated for statistical significance using unpaired students t-tests RESULTS: A total of 3668 patient encounters for patients on MV were included in the assessment [(207 C-19P (5 6%) vs 3461 (94 4%) C-19N)] Duration of MV was significantly longer in the C-19P cohort, 10 6 (5 4, 19 3) days, compared to the C-19N cohort, 1 6 (0 5, 5) days, p<0 0001 There was an increase in utilization of analgesic infusions (MME per patient per day) in C-19P in comparison to C-19N: fentanyl (459 vs 523), hydromorphone (193 vs 286), and morphine (94 vs 107) Similarly, there was in increase in utilization of sedatives (dose per patient per day) in C-19P in comparison to C-19N: dexmedetomidine (1028 mcg vs 1424 mcg), propofol (3589 mg vs 4583 mg), and lorazepam (90 mg vs 98 mg) In contrast, no increases in ketamine or midazolam infusions utilization were noted CONCLUSIONS: We observed a marked increase in most sedative and analgesia requirements in COVID-19 MV patients which could be, in part, related to patient acuity This observation may inform healthcare institutions when considering sedative and analgesic procurement