Department of Anesthesiology, Shenzhen People's Hospital, Shenzhen, China.
Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital, No. 1017 Dongmen North Road, Shenzhen, 518020, Guangdong, China.
Drugs R D. 2021 Jun;21(2):149-155. doi: 10.1007/s40268-021-00338-3. Epub 2021 Apr 19.
Opioids are potent painkillers but can have severe adverse effects in the intensive care unit (ICU). The aim of this study was to compare the outcomes of fentanyl and morphine use among patients at risk for and with acute respiratory distress syndrome (ARDS).
We developed a dataset of real-world data to enable the comparison of the effectiveness and safety of opioids and the associated outcomes from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC)-III database and the eICU Collaborative Research Database. Patients who were admitted to the ICU with a diagnosis of or at risk for ARDS and received mechanical ventilation for at least 12 h were included. Patients were enrolled sequentially into one of six groups in three cohorts: treated with fentanyl or not; treated with morphine or not; and treated with fentanyl or morphine. Propensity score matching and multivariable analyses were performed.
Fentanyl was associated with higher in-hospital mortality in the propensity score-matched model but not in the linear regression model. The use of morphine was associated with a higher in-hospital mortality in both models. Both fentanyl and morphine were associated with longer duration of mechanical ventilation, ICU stay, and hospitalization and a decreased likelihood of being discharged home in both models. Notably, compared with morphine, fentanyl was associated with a lower mortality and an increased likelihood of being discharged home.
Both fentanyl and morphine were independent risk factors for worse outcomes in patients with or at risk for ARDS. Compared with morphine, fentanyl may be preferred in these patients.
阿片类药物是强效止痛药，但在重症监护病房（ICU）中会产生严重的不良反应。本研究旨在比较芬太尼和吗啡在急性呼吸窘迫综合征（ARDS）风险患者和 ARDS 患者中的使用效果和安全性。
我们开发了一个真实世界数据的数据集，以比较来自 Multiparameter Intelligent Monitoring in Intensive Care（MIMIC-III）数据库和 eICU 协作研究数据库的阿片类药物的有效性和安全性以及相关结果。纳入 ICU 入院诊断为 ARDS 或有 ARDS 风险且至少接受 12 小时机械通气的患者。患者按以下三种队列中的六组顺序入组：接受芬太尼治疗或不接受；接受吗啡治疗或不接受；接受芬太尼或吗啡治疗。进行了倾向评分匹配和多变量分析。
在倾向评分匹配模型中，芬太尼与更高的院内死亡率相关，但在线性回归模型中不相关。吗啡的使用与两种模型中的更高院内死亡率相关。芬太尼和吗啡都与更长的机械通气时间、ICU 住院时间和住院时间以及两种模型中更不可能出院回家相关。值得注意的是，与吗啡相比，芬太尼与更低的死亡率和更高的出院回家可能性相关。
芬太尼和吗啡都是 ARDS 患者或有 ARDS 风险患者不良结局的独立危险因素。与吗啡相比，芬太尼可能更适合这些患者。
