Principal Investigator, Clinical Pharmacist, Riverside Methodist Hospital, Columbus, Ohio. OR-CID: https://orcid.org/0000-0001-6438-5315.
Sub-Investigator, Medical ICU Clinical Pharmacist, Riverside Methodist Hospital, Colum-bus, Ohio. ORCID: https://orcid.org/0000-0002-3254-7938.
J Opioid Manag. 2022 May-Jun;18(3):223-228. doi: 10.5055/jom.2022.0713.
The 2018 Pain, Agitation/Sedation, Delirium, Immobility, and Sleep guidelines from the Society of Critical Care Medicine recommend opioids as a first-line treatment option for non-neuropathic pain among critically ill adults and prioritize pain management optimization before the administration of sedatives. Although analagosedation is recommended, the downstream effects, such as intensive care unit (ICU)-acquired opioid dependence, are not well described. The purpose of this study is to determine the impact of continuous infusions of opioids for mechanically ventilated patients prescribed opioids on discharge.
This was a single-center, retrospective chart review of mechanically ventilated patients admitted to the medical ICU at a tertiary medical center from July 1, 2018 to June 30, 2019. The primary objective of this study was to compare the incidence of opioid prescriptions at discharge between those who received opioid infusions versus intermittent administrations. Secondary objectives included risk factors for receiving opioid prescriptions at discharge and readmission within 90 days with an active opioid prescription and/or a diagnosis of opioid use disorder.
A total of 100 patients were included. There was no statistically significant difference in the incidence of opioid prescriptions at discharge between the groups (p = 0.933). Only one patient was readmitted within 90 days with documented opioid use disorder and 11 patients with prescription opioids on their home medication list. A best-fit logistic regression model including the type of opioid administration (p = 0.275), length of stay (p = 0.018), and opioid dose (p = 0.137) showed that length of stay was the only significant predictor of discharge opioid prescribing.
The incidence of opioid prescriptions at discharge for critically ill, mechanically ventilated patients did not differ based on opioid administration strategy. ICU length of stay appears to be a predictive factor of opioid discharge prescriptions.
重症监护医学学会 2018 年疼痛、躁动/镇静、谵妄、活动受限和睡眠指南建议将阿片类药物作为成人危重病患者非神经性疼痛的一线治疗选择，并在使用镇静剂之前优先优化疼痛管理。尽管推荐使用analagosedation，但 ICU 获得的阿片类药物依赖等下游影响尚未得到很好的描述。本研究的目的是确定为机械通气患者开具阿片类药物处方时持续输注阿片类药物对出院的影响。
这是一项单中心、回顾性病历审查，纳入了 2018 年 7 月 1 日至 2019 年 6 月 30 日期间在三级医疗中心的内科重症监护病房（medical ICU）接受机械通气的患者。本研究的主要目的是比较接受阿片类药物输注与间歇性给药的患者出院时开具阿片类药物处方的发生率。次要目标包括出院时开具阿片类药物处方的风险因素，以及在 90 天内因有活性阿片类药物处方和/或阿片类药物使用障碍诊断而再次入院。
共纳入 100 例患者。两组患者出院时开具阿片类药物处方的发生率无统计学差异（p = 0.933）。只有 1 例患者在 90 天内因记录的阿片类药物使用障碍和 11 例患者因家庭用药清单上有阿片类药物处方而再次入院。一个包含阿片类药物给药类型（p = 0.275）、住院时间（p = 0.018）和阿片类药物剂量（p = 0.137）的最佳拟合逻辑回归模型表明，住院时间是出院时开具阿片类药物处方的唯一显著预测因素。
机械通气的危重病患者出院时开具阿片类药物处方的发生率与阿片类药物给药策略无关。ICU 住院时间似乎是出院时开具阿片类药物处方的预测因素。
