Opioid versus Benzodiazepine-based Sedation for Mechanically Ventilated Patients in the Internat Medicine Ward

Background: Opioid-base sedation is considered the first line choice in ventilated patients in intensive care units (ICU). Few studies have examined sedation in ventilated patients outside the ICU. A pilot program was initiated in an internat medicine ward at Meir Hospital in Kfar Saba, Israel. A new sedation protocol was implemented for opioid-based vs. benzodiazepine-based sedation in ventilated patients. Objectives: To compare the rates and intensity of delirium between patients who received opioid-based sedation vs. benzodiazepine-based sedation. To compare parameters related to morbidity and mortality. Methods: We conducted a retrospective before-after intervention study based on data collection. Patients who were admitted to an internat medicine ward from January 2020 to January 2021 and required sedation and ventilation were included. Demographic data, medical history data, admission data, Richmond Agitation and Sedation Scale scores, hemodynamic parameters, reports of falls and self-harm, and data regarding unplanned extubation were collected, as weil as the need for additional sedative drugs. Results: Chronic hypertension was more common in the opioid group. Delirium intensity tended to be higher in the benzodiazepine group. The number of ventilation days was significantly higher in the benzodiazepine group, as was the number of times adjuvant sedation was required. Conclusions: Opioid-based sedation outside the ICU was associated with shorter ventilation days, tendency toward lower intensity of delirium, and reduction in requirement of adjuvant sedative drugs compared to benzodiazepine-based sedation. Further studies are required to confirm the findings.