Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug 5;7(3):192-198.
doi: 10.2478/jccm-2021-0026. eCollection 2021 Jul.

Analgosedation: The Use of Fentanyl Compared to Hydromorphone

Hahnl Choi  1 , Sara Radparvar  1 , Samuel L Aitken  2 , Jerry Altshuler  3
Affiliations

Analgosedation: The Use of Fentanyl Compared to Hydromorphone

Hahnl Choi et al. J Crit Care Med (Targu Mures). .

Abstract

Background: The 2018 Society of Critical Care Medicine guidelines on the "Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU" advocate for protocol-based analgosedation practices. There are limited data available to guide which analgesic to use. This study compares outcomes in patients who received continuous infusions of fentanyl or hydromorphone as sedative agents in the intensive care setting.

Methods: This retrospective cohort study evaluated patients admitted into the medical intensive care unit, the surgical intensive care unit, and the cardiac intensive care unit from April 1, 2017, to August 1, 2018, who were placed on continuous analgesics. Patients were divided according to receipt of fentanyl or hydromorphone as a continuous infusion as a sedative agent. The primary endpoints were ICU length of stay and time on mechanical ventilation.

Results: A total of 177 patients were included in the study; 103 received fentanyl as a continuous infusion, and 74 received hydromorphone as a continuous infusion. Baseline characteristics were similar between groups. Patients in the hydromorphone group had deeper sedation targets. Median ICU length of stay was eight days in the fentanyl group compared to seven days in the hydromorphone group (p = 0.11) and median time on mechanical ventilation was 146.47 hours in the fentanyl group and 122.33 hours in the hydromorphone group (p = 0.31). There were no statistically significant differences in the primary endpoints of ICU length of stay and time on mechanical ventilation between fentanyl and hydromorphone for analgosedation purposes.

Conclusion: No statistically significant differences were found in the primary endpoints studied. Patients in the hydromorphone group required more tracheostomies, restraints, and were more likely to have a higher proportion of Critical Care Pain Observation Tool (CPOT) scores > 2.

Keywords: agitation; analgesic; analgosedation; pain; sedation.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Conflict of Interests: The author(s) declared no potential conflicts of interest concerning the research, authorship, and publication of this article.

References

    1. Devabhakthuni S, Armahizer M, Data J. Analgosedation: A paradigm shift in intensive care unit sedation practice. Ann Pharmacother. 2012;46(4):530–40. et al. - PubMed
    1. Devlin JW, Skrobik Y, Gélinas C. 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:e825–73. et al. - PubMed
    1. Faust AC, Rajan P, Sheperd LA. Impact of an Analgesia-Based Sedation Protocol on Mechanically Ventilated Patients in a Medical Intensive Care Unit. Anesth Analg. 2016;123(4):903–9. et al. - PMC - PubMed
    1. Dahab AA, Grabner T, Rehak PH. Remifentanil versus morphine analgesia and sedation for mechanically ventilated critically ill patients: a randomised double-blind study. Anesthesiology. 2004;101:640–646. et al. - PubMed
    1. Breen D, Karabinis A, Malbrain M. Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic-based sedation for up to 10 days in intensive care unit patients: a randomised trial. Crit Care. 2005;9:R200–R210. et al. - PMC - PubMed

LinkOut - more resources