Delirium in ventilated patients receiving fentanyl and morphine for Analgosedation: Findings from the ANALGESIC trial

Andrew Casamento; Ary Serpa Neto; Mervin Lawrence; Laura Chudleigh; Emma Browne; Christina Taplin; Glenn M Eastwood; Rinaldo Bellomo

doi:10.1016/j.jcrc.2023.154343

Delirium in ventilated patients receiving fentanyl and morphine for Analgosedation: Findings from the ANALGESIC trial

J Crit Care. 2023 Oct:77:154343. doi: 10.1016/j.jcrc.2023.154343. Epub 2023 May 24.

Authors

Andrew Casamento¹, Ary Serpa Neto², Mervin Lawrence³, Laura Chudleigh⁴, Emma Browne⁵, Christina Taplin⁶, Glenn M Eastwood⁷, Rinaldo Bellomo⁸

Affiliations

¹ Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Intensive Care, Northern Hospital, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia. Electronic address: Andrew.casamento@austin.org.au.
² Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Data Analytics Research & Evaluation (DARE) Center, University of Melbourne and Austin Hospital, Melbourne, Australia; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. Electronic address: Ary.serpaneto@austin.org.au.
³ Department of Intensive Care, Northern Hospital, Melbourne, Australia. Electronic address: Mervin.lawrence@nh.org.au.
⁴ Department of Intensive Care, Northern Hospital, Melbourne, Australia.
⁵ Department of Intensive Care, Northern Hospital, Melbourne, Australia. Electronic address: Emma.browne@nh.org.au.
⁶ Department of Intensive Care, Northern Hospital, Melbourne, Australia. Electronic address: Christina.taplin@nh.org.au.
⁷ Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. Electronic address: Glenn.eastwood@austin.org.au.
⁸ Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Data Analytics Research & Evaluation (DARE) Center, University of Melbourne and Austin Hospital, Melbourne, Australia. Electronic address: Rinaldo.bellomo@austin.org.au.

PMID: 37235918
DOI: 10.1016/j.jcrc.2023.154343

Abstract

Purpose: The differential effect of fentanyl vs. morphine analgosedation on the development of hospital inpatient delirium in patients receiving mechanical ventilation is unknown. We aimed to compare the incidence of coding for delirium and antipsychotic medication use in patients treated with fentanyl vs. morphine in the ANALGESIC trial.

Materials and methods: We obtained data from a cluster randomized, cluster crossover trial of fentanyl vs. morphine for analgosedation on antipsychotic use and coding diagnosis of delirium and compared these outcomes according to treatment allocation. We assessed the relationship between opioid choice and dose, hospital inpatient delirium, and outcomes.

Results: Among 681 patients enrolled in the ANALGESIC trial, 160/344 (46.5%) in the fentanyl group vs. 132/337 (39.1%) in the morphine group (absolute difference 7.34% [95% CI -0.9 to 14.78]; RR: 1.19 [95%CI 1.00 to 1.41]; p = 0.053) developed hospital inpatient delirium. Antipsychotic use was linearly related to opioid dose. Antipsychotic use was not associated with increased mortality.

Conclusions: Fentanyl is associated with a higher incidence of hospital inpatient delirium when used for analgosedation compared with morphine, and the dose of opioid is linearly related to the need for antipsychotic medication administration. The role of analgosedation in promoting delirium requires further investigation.

Keywords: Analgosedation; Delirium; Mechanical ventilation; Opioids.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Analgesics
Analgesics, Opioid / adverse effects
Antipsychotic Agents* / therapeutic use
Delirium* / chemically induced
Delirium* / drug therapy
Delirium* / epidemiology
Fentanyl / adverse effects
Humans
Morphine / adverse effects
Respiration, Artificial / adverse effects

Substances

Fentanyl
Morphine
Analgesics, Opioid
Antipsychotic Agents
Analgesics