Extracorporeal membrane oxygenation and diurnal analgosedation: A comparative retrospective study in ventilated patients.

BACKGROUND

Diurnal variation of analgosedation may worsen patient outcomes. However, there is no data reporting diurnal variation in patients receiving extracorporeal membrane oxygenation (ECMO).

OBJECTIVES

To compare diurnal variation of analgosedation doses in mechanically ventilated adult patients and those receiving ECMO.

SETTING

Five ICUs (65 beds) including an ECMO unit, with patient recruitment from July 2021 to July 2023.

METHODS

Retrospective single-centre cohort study including patients aged ≥ 16 years receiving continuous intravenous (IV) opioid (fentanyl) and/or sedative (midazolam and/or propofol), receiving mechanical ventilation with or without ECMO. We collected data on all intravenous analgosedation doses (excluding boluses) from 07:00 to 18:59 (day) or from 19:00 to 06:59 (nighttime) for 48 h.

RESULTS

We identified 1277 patients; of whom 166 (13.0 %) received ECMO and 1111 (87.0 %) received no ECMO. Most were male 815 (63.8 %), median (interquartile range (IQR)) age 58 (42-70) years. We found no diurnal variation of analgosedation doses in ECMO patients. However, we found higher doses of fentanyl (mean difference 1.7 µg/kg, 95 % Confidence Interval (CI): 1.0, 2.4 μg/kg, p < 0.001) and propofol (mean difference 2.3 mg/kg, 95 % CI: 1.7, 2.9 mg/kg, p < 0.001) at nighttime compared to daytime in non-ECMO patients. A higher proportion of ECMO patients received neuromuscular blocking drugs compared to non-ECMO group 120 (72.3 %) vs 138 (12.4 %); p < 0.001.

CONCLUSIONS

We found higher doses of fentanyl and propofol IV infusion doses at nighttime in non-ECMO patients. However, we found no diurnal variation of analgosedation doses in ECMO patients, most likely due to deep sedation and use of neuromuscular blocking medicines.

IMPLICATIONS FOR CLINICAL PRACTICE: Patient factors, critical illness factors and type of ICU admission are likely contributory factors to differences in diurnal variation of analgosedation doses in ECMO and non-ECMO populations.