Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, United States of America.
Division for Pulmonary, Critical Care, and Sleep Medicine, Beth, Israel Deaconess Medical Center, Boston, MA, United States of America.
J Crit Care. 2019 Dec;54:42-47. doi: 10.1016/j.jcrc.2019.06.032. Epub 2019 Jun 29.
Opioid associated admissions to the Intensive Care Unit (ICU) are increasing, but how institutions manage the care of these patients is unknown. We studied the availability of protocols and guidelines in Intensive Care Units (ICUs) for the management of the critically ill patient with opioid use disorder.
A survey was sent to a random sampling of ICU clinicians at acute care hospitals in the United States.
Of the 300 hospitals contacted, 118 agreed to participate and 58 submitted surveys (49%, 58/118 response rate). While a majority of ICUs has a guideline to titrate sedative analgesics, only 7% reported a guideline that addresses the sedation needs of patients with opioid use disorder. Only one respondent identified a guideline for the continuation of medication-assisted treatment such as methadone. Most respondents did not have, or were unaware of, a guideline to manage opioid withdrawal or to prevent over-reversal with naloxone. Outpatient resources were offered to patients by 36% of institutions, while even fewer reported the use of a dedicated addiction care team.
Few institutional guidelines exist to provide clinicians with the tools necessary to prevent harm and promote recovery for this growing and vulnerable ICU population.
阿片类药物相关的 ICU 入院人数正在增加，但目前尚不清楚医疗机构如何管理这些患者的治疗。我们研究了 ICU 中针对阿片类药物使用障碍的危重症患者管理的协议和指南的可获得性。
我们向美国急性护理医院的 ICU 临床医生进行了随机抽样调查。
在联系的 300 家医院中，有 118 家同意参与，58 家提交了调查（49%，58/118 的回复率）。尽管大多数 ICU 都有指导意见来滴定镇静镇痛药物，但只有 7%的 ICU 报告了针对阿片类药物使用障碍患者镇静需求的指南。只有一位受访者确定了美沙酮等药物辅助治疗的延续性指南。大多数受访者没有或不知道管理阿片类药物戒断或防止纳洛酮过度逆转的指南。36%的机构为患者提供了门诊资源，而更少的机构报告使用专门的成瘾护理团队。
很少有机构指南为临床医生提供预防此类不断增长且脆弱的 ICU 人群受到伤害和促进康复所需的工具。
