A Comparative Study of Fentanyl Versus Hydromorphone in Mechanically Ventilated Intensive Care Unit Patients

Background: Although the SCCM PADIS guidelines suggest fentanyl or hydromorphone infusions for analgesia during mechanical ventilation (MV), few studies compare patient-centered outcomes. Objective: This study evaluated therapeutic outcomes and adverse effects of fentanyl and hydromorphone in MV intensive care unit patients. Methods: This single-center, retrospective cohort study evaluated adult MV patients who were intubated for 1 to 14 days and received either hydromorphone or fentanyl infusion for analgesia, while targeting light sedation. The primary endpoint was 28-day MV-free survival. Select secondary endpoints included cumulative and hourly opioid doses during MV, duration of MV, and time within goal pain and sedation score ranges during MV. Multivariate regression analysis was performed for patients intubated more than 72 hours. Results: A total of 238 patients were included; 144 received fentanyl and 94 received hydromorphone. Baseline characteristics were similar between groups with a median age of 66 years, weight 78 kg, and 33% female. Median 28-day MV-free survival was 22 and 21 days for the fentanyl and hydromorphone groups, respectively ( P = 0.36). Patients given fentanyl received higher cumulative opioid doses, expressed in fentanyl equivalents, during MV compared to hydromorphone-treated patients, 4241 (interquartile range [IQR] 1817-8146) mcg and 2448 (IQR 1012-4926) mcg ( P < 0.001), respectively, and higher hourly average doses, 55 (IQR 39-75) mcg/h and 37 (IQR 29-51) mcg/h ( P < 0.001), respectively. Conclusion and Relevance: There was no difference in 28-day MV-free survival with fentanyl- and hydromorphone-based analgesia, but hydromorphone was associated with lower cumulative and hourly opioid requirements.