College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
BMJ Open. 2019 Jul 23;9(7):e026605. doi: 10.1136/bmjopen-2018-026605.
Clinical practice guidelines for the management of pain and sedation in critically ill patients have been developed and applied; however, there is limited data on medication use among elderly patients. This study identifies current practice patterns for analgo-sedative use in mechanically ventilated elderly patients in Korea using a national claims database.
Cross-sectional study.
Ventilated elderly patients aged 65 years or older in intensive care units (ICUs) from an aged patients' national claims database in Korea PRIMARY OUTCOME MEASURES: Use of sedatives including benzodiazepines, opioids and non-opioid analgesics, neuromuscular blocking agents (NMBAs) and antipsychotic drugs were analysed by the duration of mechanical ventilation (MV), age and time.
From 2012 to 2016, 22 677 elderly patients underwent MV in 267 general or tertiary ICUs. Mean age was 77.2 (±6.9) years and the median duration of MV was 4.1 days; 77.2% of patients received sedatives, 65.0% analgesics, 29.1% NMBAs and 19.6% antipsychotics. Midazolam (62.0%) was the most commonly prescribed medication. The proportions of sedatives, analgesics and NMBAs increased, whereas the percentages of person-days decreased with longer MV duration (p<0.01). With advanced age, the prevalence and duration of sedative, analgesic and NMBA use decreased (adjusted OR (95% CI) 0.98 (0.97 to 0.98) in all three classes) while antipsychotic did not (adjusted OR 1.00 (1.00-1.01)). Annually, benzodiazepines showed reduced administration (76.2% in 2012 and 71.4% in 2016, p<0.01), while daily opioid dose increased (21.6 in 2012 vs 30.0 mg in 2016, p<0.01).
The prevalence of sedative, analgesic and NMBAs use and daily opioid doses were lower, whereas antipsychotic use was higher compared with those in previous studies in adult patients. The findings warrant further studies investigating appropriateness and safety of medication use that consider clinical severity scores with a focus on elderly patients in ICUs.
已制定并应用了针对危重症患者疼痛和镇静管理的临床实践指南；然而，关于老年患者药物使用的数据有限。本研究使用韩国全国索赔数据库，确定了目前机械通气老年患者在重症监护病房（ICU）中使用镇痛镇静药物的治疗模式。
横断面研究。
来自韩国老年患者全国索赔数据库中年龄在 65 岁或以上的接受机械通气的 ICU 老年患者。
通过机械通气（MV）持续时间、年龄和时间分析镇静剂（包括苯二氮䓬类、阿片类药物和非阿片类镇痛药）、神经肌肉阻滞剂（NMBA）和抗精神病药物的使用。
2012 年至 2016 年，267 家普通或三级 ICU 中有 22677 名老年患者接受 MV。平均年龄为 77.2（±6.9）岁，MV 中位数持续时间为 4.1 天；77.2%的患者接受镇静剂，65.0%接受镇痛药，29.1%接受 NMBA，19.6%接受抗精神病药。咪达唑仑（62.0%）是最常用的药物。随着 MV 持续时间的延长，镇静剂、镇痛药和 NMBA 的比例增加，而每人每天的比例降低（所有三类药物 p<0.01）。随着年龄的增长，镇静剂、镇痛药和 NMBA 的使用频率和持续时间下降（调整后的 OR（95%CI）为 0.98（0.97 至 0.98）），而抗精神病药则没有（调整后的 OR 为 1.00（1.00 至 1.01））。每年，苯二氮䓬类药物的给药量减少（2012 年为 76.2%，2016 年为 71.4%，p<0.01），而每日阿片类药物剂量增加（2012 年为 21.6mg，2016 年为 30.0mg，p<0.01）。
与成人患者的先前研究相比，镇静剂、镇痛药和 NMBA 的使用率和每日阿片类药物剂量较低，而抗精神病药物使用率较高。这些发现需要进一步研究，以评估考虑 ICU 老年患者临床严重程度评分的药物使用的适当性和安全性。
