Choice of initial opioid for continuous infusions in patients receiving mechanical ventilation: a retrospective cohort study
Authors' conclusion
Across 20 ICUs in Alberta, Canada, there were temporal changes and significant inter-ICU variability in opioid-prescribing practices for patients receiving mechanical ventilation.
Study context
- Population
- Patients receiving Mechanical Ventilation (MV) in Intensive Care Unit (ICUs) in Alberta, Canada, 2013–2019admissions in 20 ICUs
- Participants
- 17,898 patients
- Exposure
- Choice of first opioid infusion: fentanyl vs hydromorphone vs morphine
- Fentanyln = 14,060reference
- Hydromorphonen = 2,917
- Morphinen = 921
- Outcome
- Temporal trends in, and factors associated with, the choice of first opioid infusion
Methodological detailshistorical cohort, multicentre, multilevel multinomial logistic regression
- Historical cohort
- Multicentre
- Multilevel multinomial logistic regression
Main finding
As reported in the abstract
Initial opioid infusion
- Fentanyl use decreased from 2013 to 2019 (1,468/1,650 vs 1,763/2,351)
- 89.0% to 75.0%; P < 0.001
- Morphine use decreased from 2013 to 2019 (127/1,650 vs 75/2,351)
- 7.7% to 3.2%; P < 0.001
- Hydromorphone use increased from 2013 to 2019 (55/1,650 vs 513/2,351)
- 3.3% to 21.8%; P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | |
|---|---|---|
| Surgical patients: opioid choice vs fentanylHydromorphone vs Fentanyl · surgical patients more likely to receive hydromorphone | aOR 1.52 (95% CI 1.32–1.74) | |
| Surgical patients: opioid choice vs fentanylMorphine vs Fentanyl · surgical patients less likely to receive morphine | aOR 0.81 (95% CI 0.68–0.96) | |
| Inter-ICU variability in opioid useHydromorphone vs Fentanyl · substantial inter-ICU variability | aMOR 14.5 (95% CI 7.3–25.7) | |
| Inter-ICU variability in opioid useMorphine vs Fentanyl · substantial inter-ICU variability | aMOR 5.2 (95% CI 3.11–9.2) | |
| 0.050.21520Ratio (log scale) |
Original publication
Choice of initial opioid for continuous infusions in patients receiving mechanical ventilation: a retrospective cohort study. Can J Anaesth. Published 2 September 2026. doi:10.
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