Table 6.
Variability of Opioid and Benzodiazepine Use by Clinical Site, N=419
| Variable | A | B | C | D | E | F | G | |
|---|---|---|---|---|---|---|---|---|
| Opioids | Median (IQR) | Median (IQR) | Median (IQR) | Median (IQR) | Median (IQR) | Median (IQR) | Median (IQR) | p |
|
| ||||||||
| Baseline opioid dose (μg/kg) | 48 (29, 58) | 54 (35, 87) | 41 (29, 59) | 24 (15, 30) | 77 (57, 97) | 14 (9, 19) | 37 (28, 70) | < .001 |
| Average daily dose (μg/kg) | 42 (30, 54) | 49 (32, 76) | 37 (27, 65) | 26 (15, 41) | 44 (20, 68) | 9 (6, 13) | 46 (14, 70) | < .001 |
| Total cumulative dose (μg/kg) | 281 (124, 531) | 320 (129, 682) | 227 (102, 458) | 169 (64, 463) | 202 (102, 394) | 39 (18, 100) | 291 (71, 634) | < .001 |
| Peak infusion rate (μg/kg/hr) | 3.0 (2.0, 4.0) | 4.0 (3.0, 6.0) | 2.5 (2.0, 4.8) | 1.5 (1.0, 2.5) | 4.0 (3.0, 5.0) | 0.4 (0.3, 0.6) | 3.0 (2.0, 5.0) | < .001 |
| Duration of opioid infusion (hrs) | 132 (77, 240) | 134 (69, 254) | 115 (65, 198) | 161 (80, 287) | 60 (34, 99) | 75 (40, 158) | 100 (45, 204) | < .001 |
| Duration on study (hrs) | 169 (82, 275) | 148 (75, 260) | 136 (83, 218) | 178 (81, 298) | 123 (77, 174) | 83 (53, 167) | 136 (60, 233) | .009 |
|
| ||||||||
| n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | ||
|
| ||||||||
| Primary Opioid Used | ||||||||
| Fentanyl | 57 (95) | 54 (98) | 42 (52) | 24 (30) | 46 (88) | 5 (8) | 30 (100) | < .001 |
| Morphine | 3 (5) | 1 (2) | 39 (48) | 55 (70) | 6 (12) | 57 (92) | 0 (0) | |
| Primary outcome at 7 days | 12 (20) | 6 (11) | 20 (25) | 18 (23) | 0 (0) | 2 (3) | 8 (27) | <.001 |
| Primary outcome at 14 days | 19 (32) | 10 (18) | 22 (27) | 21 (27) | 0 (0) | 2 (3) | 9 (30) | < .001 |
|
| ||||||||
| Benzodiazepines | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | |
|
| ||||||||
| Any benzodiazepine used | 56 (93) | 49 (89) | 67 (83) | 77 (97) | 51 (98) | 58 (94) | 29 (97) | .01 |
| Midazolam used | 36 (60) | 21 (38) | 66 (81) | 76 (96) | 51 (98) | 18 (29) | 26 (87) | < .001 |
| Lorazepam used | 47 (78) | 44 (80) | 24 (30) | 34 (43) | 11 (21) | 55 (89) | 20 (67) | < .001 |
|
| ||||||||
| Median (IQR) | Median (IQR) | Median (IQR) | Median (IQR) | Median (IQR) | Median (IQR) | Median (IQR) | ||
|
| ||||||||
| Days receiving benzodiazepines | 4 (3, 8) | 4 (3, 7) | 6 (3, 10) | 8 (4, 13) | 5 (4, 8) | 3 (2,6) | 5 (3, 10) | < .001 |
| Average daily dose (mg/kg)* | 0.2 (0.1, 0.3) | 0.2 (0.1, 0.4) | 2.4 (1.1, 4.1) | 2.1 (1.4, 3.6) | 2.9 (1.7, 4.2) | 0.2 (0.1, 0.4) | 1.5 (0.8, 3.2) | < .001 |
| Total cumulative dose (mg/kg) | 0.6 (0.3, 2.5) | 0.9 (0.4, 2.5) | 11.9 (3.0, 28.7) | 15.7 (6.0, 31.0) | 13.7 (5.4, 29.6) | 0.6 (0.3, 1.9) | 5.4 (2.6, 20.2) | < .001 |
IQR = interquartile range (25th, 75th percentile); Primary Outcome was defined as doubling of the initially effectiveopioid dose (0–24 hours of therapy). All totals included infusion and bolus doses; morphine doses were converted to fentanyl equivalents using well-defined opioid potency ratios (1:80).
*
Average daily benzodiazepine dose is based only on the days when any benzodiazepines were received.