Variable Patterns of Continuous XXXX Infusions at End of Life.

@entity1 @entity1353 @entity158 @entity1286 @entity204
BACKGROUND: Continuous @entity1286 infusions (CMIs) treat @entity158 and @entity1353 at the end of life (EOL). CMIs may be initiated at an empiric rate and/or are rapidly escalated without proper titration. OBJECTIVE: The study objective was to evaluate CMI patterns at the EOL. METHODS: This single-center, retrospective chart review evaluated adult @entity1 who died while receiving CMI at EOL. @entity1 demographics and opioid dosing information were extracted from an electronic medical record. Twenty-four hour IV @entity1286 equivalent was calculated prior to CMI initiation and at the time of @entity204 . RESULTS: Of the 190 @entity1 charts, 63.2% (n=120) received no bolus doses prior to CMI initiation. Mean 24-hour IV @entity1286 equivalent prior to CMI initiation was 49.3   mg (range: 0-1200   mg, SD 384.9) and at time of @entity204 was 267.1   mg (12.0-5193.2   mg, SD 442.2), representing an increase of +442%. Mean CMI starting rate was 3.3   mg/hour (0.4-30.0   mg/hour, SD 3.6) with titration at time of @entity204 to a mean of 7.7   mg/hour (0.4-70.0   mg/hour, SD 9.4), representing an increase of +130%. Mean number of CMI rate adjustments was 2.5 (0-5, SD 3.3); and number of bolus doses administered between titrations was 4.2 (0-27, SD 4.8). Mean time from CMI initiation to @entity204 was 15.5 hours (0.05-126.9 hours, SD 21.7). There was a negative association between rate of infusion increase per hour and total number of hours on CMI (r=-0.2, p=0.0062). CONCLUSIONS: Hospitalized @entity1 at EOL had a much higher 24-hour IV @entity1286 equivalents and CMI rates at time of @entity204 compared to CMI initiation. Variability was observed in the number of CMI rate adjustments and the number of bolus doses administered.
