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849: DECREASING BENZODIAZEPINE USE DOES NOT NECESSARILY INCREASE OPIOID USE IN THE CRITICAL CARE SETTING

Introduction/Hypothesis: Historically, benzodiazepines have been used synergistically with opioids to reduce excessive exposure to either particular class of medications. However, because benzodiazepines have been shown to be deliriogenic, a quality initiative was undertaken within our institution to decrease their use. The purpose of this study was to compare how this practice change has impacted length of stay (LOS), length of mechanical ventilation (LOMV), concurrent opioid use, and alpha agonist exposure in mechanically ventilated patients with acute respiratory failure within our PICU. Methods: Single-center retrospective study comparing total opioid, benzodiazepine, and alpha agonist exposure among two cohorts of mechanically ventilated patients within the PICU during two time periods, 1/1/17-12/31/17 and 6/1/18-5/31/19. Results: Seventy-three children with acute respiratory failure were included; 38 in the first cohort, and 35 in the second. There were no differences in the ages, gender, illness severity scores, primary diagnoses, LOS or LOMV between the two cohorts. As expected, total dose of benzodiazepines per day decreased in the second cohort with a median of 0.1 (IQR 0.07-0.14) vs. 0.2 (0.08-0.47) lorazepam equivalents/kg/day (p= 0.005). Despite this, there was no significant difference between the two cohorts in regards to the duration or total opioid dose per day with a median of 1.67 in the first cohort (IQR 0.74-2.84) vs. 1.93 (IQR 0.43-2.83) morphine equivalents/kg/day. Similarly, there was no difference in the duration or total dose of dexmedetomidine or clonidine. While total dosage of opioids or benzodiazepines did not correlate with LOS or LOMV, calendar days of IV fentanyl strongly correlated with LOS (R2=0.83; p<0.0001) and LOMV (R2=0.87; p<0.0001) as did calendar days of morphine and versed (LOS (R2=0.33 and R2=0.13 respectively)) (LOMV (R2=0.40 and R2=0.13 respectively)). Conclusions: While total benzodiazepine use decreased following our practice change, we found no significant change in opioid use. Furthermore, decreasing total benzodiazepine use had no impact on length of stay or length of mechanical ventilation. More research is required to assess whether these changes in practice are associated with a change in the incidence of pediatric delirium.