University of Colorado Hospital, Aurora, CO, USA.
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
Ann Pharmacother. 2020 Nov;54(11):1065-1072. doi: 10.1177/1060028020919122. Epub 2020 Apr 30.
Opioids are utilized for pain management during and after mechanical ventilation in the intensive care unit (ICU).
The purpose of this study was to determine the percentage of potentially unnecessary opioid prescriptions on discharge in previously opioid-naïve patients.
This retrospective cohort study included mechanically ventilated, opioid-naïve ICU patients who received opioids. The primary outcome of this study was the discrepancy between the amounts of opioids prescribed at discharge versus those likely required based on actual 24-hour prehospital discharge opioid requirements.
A total of 71 patients were included. Of these, 63.3% (n = 45) of discharge prescriptions were in alignment with 24-hour predischarge requirements, and 36.7% (n = 26) of discharge prescriptions were in excess of calculated predischarge requirements. At discharge, 57.7% (n = 41) of patients received a nonopioid analgesic. Multivariable linear regression revealed that cardiothoracic ICU admission was associated with an increased risk of inappropriate discharge opioid prescribing, whereas a shorter duration of inpatient oral opioid therapy decreased risk of inappropriate discharge prescribing.
Opioid prescribing for previously mechanically ventilated patients warrants improvement as a part of the discharge planning process. Application of these data may aid in the reduction of opioid overprescribing at discharge after an ICU stay.
在重症监护病房（ICU）中，阿片类药物被用于机械通气期间和之后的疼痛管理。
本研究旨在确定在先前未使用过阿片类药物的患者中，出院时潜在不必要的阿片类药物处方的比例。
这项回顾性队列研究包括接受过阿片类药物治疗的机械通气、阿片类药物初治的 ICU 患者。本研究的主要结局是出院时开具的阿片类药物与根据实际出院前 24 小时阿片类药物需求计算出的所需药物之间的差异。
共纳入 71 名患者。其中，63.3%（n=45）的出院处方与 24 小时预出院需求相符，36.7%（n=26）的出院处方超过了计算出的预出院需求。出院时，57.7%（n=41）的患者接受了非阿片类镇痛药。多变量线性回归显示，心胸 ICU 入院与不适当的出院阿片类药物处方开具风险增加相关，而住院口服阿片类药物治疗时间缩短则降低了不适当出院处方开具的风险。
需要改进先前接受过机械通气的患者的阿片类药物处方开具，作为出院计划过程的一部分。应用这些数据可能有助于减少 ICU 住院后出院时阿片类药物的过度开具。
