PSHP 2026 Residency Conference

Purpose: Evaluate the overall impact of transitioning from a weight-based to non-weight-based fentanyl infusion dosing strategy in critically ill, mechanically ventilated patients in the critical care unit.
Methods: Through a retrospective electronic medical record chart review, adult patients who were admitted to the critical care unit, were mechanically ventilated and receiving a fentanyl infusion were identified for inclusion. Exclusion criteria included patients not admitted to the critical care unit, not mechanically ventilated, did not receive a fentanyl infusion for more than 24 hours, received concomitant neuromuscular blockers and patients who underwent targeted temperature management. The patient population was characterized using descriptive statistics. Students’ T-test or Mann-Whitney U tests were used for continuous variables, and Chi-squared was used to measure the association between categorical variables. Power calculation determined that 100 patients would be included to evaluate study outcomes.
Results: One hundred patients were included in the final analysis. For daily fentanyl dose, there was no statistically significant difference between pre- and post-implementation groups (p-value: 0.391). There was a statistically significant difference between groups for the maximum fentanyl infusion dose (p-value = 0.007). The subset of patients with BMI 30 or greater showed no difference between groups for daily fentanyl dose (p-value: 0.411). The difference between subset groups for maximum fentanyl infusion dose was statistically significant (p-value: 0.006). For length of stay in the critical care unit and total time spent on mechanical ventilation, there was not a statistically significant difference between groups (p-value: 0.139).
Conclusion: Implementation of a non-weight-based fentanyl infusion dosing strategy did not significantly reduce mean daily fentanyl dose compared to weight-based dosing. However, it significantly reduced maximum infusion doses, including in patients with a BMI ≥30. No significant differences were observed in ICU length of stay or duration of mechanical ventilation. These findings suggest non-weight-based dosing may reduce peak opioid exposure without compromising clinical outcomes.