The relationship of outpatient prescription narcotic use to the early implementation and manner of assisted ventilation in a community hospital intensive care unit

Methods Longmont United Hospital (LUH) is a 146 bed institution in Boulder County, Colorado. The intensive care unit is a sixteen-bed combined medical-surgical facility that provides care to any critically ill patient at LUH. Admissions were prospectively studied from January through March of 2015. Patients were evaluated for age, sex, prescription opioid use, and for the type of assisted ventilation required during the initial twentyfour hours of their stay. For purposes of this study, six prescription analgesics: oxycodone, hydrocodone, morphine, fentanyl, tramadol, and hydromorphone were included. Ventilatory assistance was defined as either intubation with mechanical ventilation or the new use of mask delivered bi-level positive airway pressure (BiPAP). Results 225 patients were enrolled. The prevalence of outpatient prescription narcotic use was 25.3%. Average ages were 62.9 years in the narcotic group, and 57.5 years in nonnarcotic group. The narcotic group demonstrated a sex distribution of 29.8% male, 70.2% female, while the nonnarcotic 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 nonnarcotic group (p < 0.05) [1]. Among those patients who required ventilatory assistance; 78.3% of patients in the narcotic group received mask BiPAP as the mode of ventilation during the first twenty-four hours of their ICU stay; while in the non-narcotic group, BiPAP was used in 15.6% of those who required assisted ventilation during their first twenty-four hours in the ICU (p < 0.05).