Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/32967
Title: Delirium in ventilated patients receiving fentanyl and morphine for Analgosedation: Findings from the ANALGESIC trial.
Austin Authors: Casamento, Andrew ;Neto, Ary Serpa;Lawrence, Mervin;Chudleigh, Laura;Browne, Emma;Taplin, Christina;Eastwood, Glenn M ;Bellomo, Rinaldo 
Affiliation: Intensive Care
Department of Critical Care, University of Melbourne, Melbourne, Australia
Department of Intensive Care, Northern Hospital, Melbourne, Australia.
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Data Analytics Research and Evaluation (DARE) Centre
Issue Date: Oct-2023
Date: 2023
Publication information: Journal of Critical Care 2023-10; 77
Abstract: 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. 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. 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. 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.
URI: https://ahro.austin.org.au/austinjspui/handle/1/32967
DOI: 10.1016/j.jcrc.2023.154343
ORCID: 
Journal: Journal of Critical Care
Start page: 154343
PubMed URL: 37235918
ISSN: 1557-8615
Type: Journal Article
Subjects: Analgosedation
Delirium
Mechanical ventilation
Opioids
Appears in Collections:Journal articles

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