Patterns of opioid prescribing in mechanically ventilated patients with septic shock

Editor—Patients receiving mechanical ventilation are frequently administered opioids for analgesia, sedation, or both—a practice recommended by consensus guidelines. 1 Devlin J.W. Skrobik Y. Gélinas C. et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018; 46: e825-e873 Crossref PubMed Scopus (1688) Google Scholar Parenteral opioids can be administered as a bolus dose, a continuous infusion, or both. Prior studies show that up to 90% of patients receiving mechanical ventilation are prescribed opioid infusions. 2 Wunsch H. Kahn J.M. Kramer A.A. Rubenfeld G.D. Use of intravenous infusion sedation among mechanically ventilated patients in the United States. Crit Care Med. 2009; 37: 3031-3039 Crossref PubMed Scopus (116) Google Scholar ,3 Burry L.D. Williamson D.R. Perreault M.M. et al. Analgesic, sedative, antipsychotic, and neuromuscular blocker use in Canadian intensive care units: a prospective, multicentre, observational study. Can J Anaesth. 2014; 61: 619-630 Crossref PubMed Scopus (68) Google Scholar However, data suggest that continuous postoperative opioid infusions do not reduce the amount of bolus opioids given to achieve adequate analgesia, nor do they decrease reported pain scores, despite significantly increasing total opioid dose. 4 Parker R.K. Holtmann B. White P.F. Patient-controlled analgesia. Does a concurrent opioid infusion improve pain management after surgery?. JAMA. 1991; 266: 1947-1952 Crossref PubMed Scopus (141) Google Scholar ,5 Chen W.H. Liu K. Tan P.H. Chia Y.Y. Effects of postoperative background PCA morphine infusion on pain management and related side effects in patients undergoing abdominal hysterectomy. J Clin Anesth. 2011; 23: 124-129 Crossref PubMed Scopus (23) Google Scholar There remains a paucity of data on the analgesic efficacy of opioid infusions in critically ill patients.