Can statins be given to an intubated patient?

Administering Statins to Intubated Patients

Yes, statins can and should be administered to intubated patients, especially those with acute coronary syndrome (ACS) or myocardial infarction (MI), as the benefits outweigh the risks. 1

Benefits of Statin Therapy in Critically Ill Patients

• Intensive statin treatment should be initiated within the first 24 hours after onset of an ACS event in all patients presenting with any form of ACS unless strictly contraindicated 1
• Statin therapy during ICU stay has been associated with a reduction in all-cause hospital mortality, particularly in high-risk subgroups 2
• For patients already on statin therapy, discontinuation during hospitalization has been associated with increased short-term mortality and major adverse cardiac events 1
• Statin therapy has shown benefit in critically ill patients with pneumonia, with a modest reduction in mortality outside of intensive care 3

Administration Considerations for Intubated Patients

• For intubated patients who cannot take oral medications, consider:
  • Crushing tablets and administering via nasogastric or orogastric tube if appropriate for the specific statin formulation 1
  • Some statins are available in different formulations that may be more suitable for administration through feeding tubes
  • Ensuring proper tube placement before administration to avoid aspiration risk

Statin Selection and Dosing

• Available statins include lovastatin, pravastatin, simvastatin, fluvastatin, and atorvastatin 1
• For ACS patients, high-intensity statin therapy is recommended to achieve LDL-C reduction of >50% 1
• Mortality reduction has been observed particularly with simvastatin (adjusted odds ratio = 0.37) compared to atorvastatin (adjusted odds ratio = 0.80) in critically ill patients 2
• The greatest benefit appears to be with statin equipotent doses ≥40 mg of simvastatin 2

Special Considerations and Monitoring

• Monitor for potential adverse effects, particularly in critically ill patients:

  • Risk of statin-induced serious muscle injury, including rhabdomyolysis, is <0.1% 4
  • Risk of serious hepatotoxicity is approximately 0.001% 4
  • Monitor creatine kinase (CK) levels if there is clinical suspicion of myopathy 1
  • If CKs are elevated to more than 10 times the upper limit of normal, consider stopping therapy 1

• Exercise caution in patients with:

  • Advanced age (especially >80 years)
  • Small body frame and frailty
  • Multisystem disease (e.g., chronic renal insufficiency)
  • Multiple medications that may interact with statins 1

Timing of Initiation

• For ACS patients, early initiation of statin therapy is recommended, ideally within 24 hours of hospital admission 1
• However, ensuring that eligible ACS patients begin statin therapy during their hospital stay is more important than emphasizing immediate statin use after admission 5
• For patients already on statin therapy prior to hospitalization, continue therapy during ICU stay unless contraindicated 1, 2

Conclusion for Clinical Practice

• Statins should be continued or initiated in intubated patients with appropriate indications, particularly those with ACS or MI 1
• The benefits of statin therapy in reducing cardiovascular events and mortality outweigh the risks in most critically ill patients 4, 2
• Proper administration techniques and monitoring can mitigate potential risks associated with statin therapy in intubated patients 1