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The Prevalence of Outpatient Prescription Narcotic Use and Its Impact on Ventilatory and Pressor Requirements in a Community Hospital Intensive Care Unit FREE TO VIEW

Charles VanHook, MD; Sigita Burneikiene, MD; Douglas Tangel, MD; Britt Warner, PA
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Longmont United Hospital, Longmont, CO

Chest. 2015;148(4_MeetingAbstracts):234A. doi:10.1378/chest.2222737
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SESSION TITLE: Critical Care Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The use of prescription opioids has increased substantially in the United States during the past twenty years. The purpose of this study was to examine the prevalence of prescription opioid use in patients admitted to a community hospital intensive care unit and to determine its relationship to the use of pressors and assisted ventilation during the first twenty-four hours of intensive care unit stay.

METHODS: Longmont United Hospital (LUH) is a 146 bed non-profit institution in Boulder County, Colorado. The intensive care unit is a sixteen-bed combined medical and surgical facility that provides care to any critically ill patient. All ICU admissions were prospectively studied during a ten week period beginning in mid-January of 2015. Patients were evaluated for age, sex, and for prescription opioid use. For the purposes of this study, six prescription analgesics: oxycodone, hydrocodone, morphine, fentanyl, tramadol, and hydromorphone were included. Patients were also evaluated for pressor support of blood pressure and for ventilatory assistance during the first twenty-four hours of their ICU stay. Ventilatory assistance was defined as either intubation with mechanical ventilation or the new use of mask delivered positive airway pressure.

RESULTS: 225 patients were enrolled. The prevalence of outpatient prescription narcotic use was 25.3%. The most commonly prescribed narcotic was oxycodone (51%). Average ages were 62.9 years (narcotic), and 57.5 years (non-narcotic). The narcotic group demonstrated a sex distribution of 29.8% male, 70.2% female, while the non-narcotic group demonstrated a distribution of 57.7% male, 42.3% female. In the narcotic group, the day-one need for ventilatory assistance was 40.4%, versus 19.1% in the non-narcotic group (p<0.05). In the narcotic group, the day-one need for pressors was 35.1%, versus 18.5% in the non-narcotic group (p<0.05).

CONCLUSIONS: There is a substantial prevalence of prescribed narcotic use among patients admitted to a community hospital combined ICU. Patients with pre-existing narcotic use demonstrated statistically significant increased needs for pharmacologic support of blood pressure and for assisted ventilation during the first twenty-four hours of their ICU stay.

CLINICAL IMPLICATIONS: Outpatient prescription narcotic use is common among patients admitted to a community hospital ICU. There is an increased early need for assisted ventilation and for pressors. Further study is warranted to evaluate comparative length of stay, morbidity, mortality, and cost.

DISCLOSURE: The following authors have nothing to disclose: Charles VanHook, Sigita Burneikiene, Douglas Tangel, Britt Warner

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