Evaluating opioid dosing in COVID-19 and Non-COVID-19 ICU patients using nociception level monitoring

Abstract

During the COVID-19 pandemic, concerns grew about excessive opioid dosing in Intensive Care Unit (ICU) patients. This study aimed to evaluate opioid dosing in the ICU by comparing objective (Nociception Level Monitor (NOL)) and subjective (Behavioral Pain Score (BPS)) pain measurement tools in COVID-19 and non-COVID-19 ICU patients. This observational study included 40 sedated, mechanically ventilated ICU patients, with half confirmed as COVID-19. Measurements included NOL, BPS, Richmond Agitation Sedation Scale (RASS), Bispectral Index (BIS) and nurse questionnaires. NOL was categorized as <10 (possible excessive analgesia), 10-25 (adequate analgesia), and >25 (possible need for more analgesia). The Time Weighted Average (TWA) assessed the duration of NOL >25 (TWANOL>25). Primary outcomes were NOL and BIS over time. COVID-19 patients received higher sufentanil (18 +/- 9 mu g/h versus 9 +/- 6 mu g/h) and propofol (307 +/- 127 mg/h versus 277 +/- 137 mg/h) doses (p < 0.001). No significant differences were found in TWANOL>25 (p = 0.78) or BPS (p = 0.1). NOL values were <10 for 63% and 57% of the time in COVID-19 and non-COVID-19 patients. BIS (p < 0.001) and RASS (p = 0.02) were lower in COVID-19 patients. While COVID-19 patients received higher opioid doses, low NOL and BPS were seen in all patients, suggesting high analgesia in all patients. Based on our data, we cannot determine whether higher opioid doses in COVID-19 were warranted.