Remifentanil use in critically Ill patients requiring mechanical ventilation is associated with increased delirium-free days: a retrospective study

Intraoperative remifentanil reduces postoperative delirium incidence, unlike other opioids; however, its efficacy in medical emergencies with organ failure is unknown. We hypothesized that remifentanil use in nonoperative intensive care unit (ICU) patients requiring ventilatory management would improve delirium outcomes. This retrospective study included 95 nonoperative patients with unplanned ICU admissions requiring ventilatory opioids. Delirium was assessed using the Intensive Care Delirium Screening Checklist. Patients were divided into remifentanil and non-remifentanil groups; statistical adjustments were made using propensity score matching and inverse probability weighting. After matching, the remifentanil group had significantly more delirium-free days (DFDs) within 14 days than the non-remifentanil group (8 [5-11] vs. 5 [3-9], p < .001). Adjusted multivariate analysis showed that DFD was significantly increased in the remifentanil group (Odds ratio = 2.639 [95% CI 1.279-5.445]; p = 0.009). Remifentanil use in nonoperative ventilated ICU patients may reduce delirium duration.