Ma Chen Hsiang, Tworek Kimberly B, Kung Janice Y, Kilcommons Sebastian, Wheeler Kathleen, Parker Arabesque, Senaratne Janek, Macintyre Erika, Sligl Wendy, Karvellas Constantine J, Zampieri Fernando G, Kutsogiannis Demetrios Jim, Basmaji John, Lewis Kimberley, Chaudhuri Dipayan, Sharif Sameer, Rewa Oleksa G, Rochwerg Bram, Bagshaw Sean M, Lau Vincent I
Department of Medicine, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada.
John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada.
Crit Care Explor. 2023 Jun 28;5(7):e0938. doi: 10.1097/CCE.0000000000000938. eCollection 2023 Jul.
While opioids are part of usual care for analgesia in the ICU, there are concerns regarding excess use. This is a systematic review of nonsteroidal anti-inflammatory drugs (NSAIDs) use in postoperative critical care adult patients.
We searched Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, trial registries, Google Scholar, and relevant systematic reviews through March 2023.
Titles, abstracts, and full texts were reviewed independently and induplicate by two investigators to identify eligible studies. We included randomized control trials (RCTs) that compared NSAIDs alone or as an adjunct to opioids for systemic analgesia. The primary outcome was opioid utilization.
In duplicate, investigators independently extracted study characteristics, patient demographics, intervention details, and outcomes of interest using predefined abstraction forms. Statistical analyses were conducted using Review Manager software Version 5.4. (The Cochrane Collaboration, Copenhagen, Denmark).
We included 15 RCTs ( = 1,621 patients) for admission to the ICU for postoperative management after elective procedures. Adjunctive NSAID therapy to opioids reduced 24-hour oral morphine equivalent consumption by 21.4 mg (95% CI, 11.8-31.0 mg reduction; high certainty) and probably reduced pain scores (measured by Visual Analog Scale) by 6.1 mm (95% CI, 12.2 decrease to 0.1 increase; moderate certainty). Adjunctive NSAID therapy probably had no impact on the duration of mechanical ventilation (1.6 hr reduction; 95% CI, 0.4 hr to 2.7 reduction; moderate certainty) and may have no impact on ICU length of stay (2.1 hr reduction; 95% CI, 6.1 hr reduction to 2.0 hr increase; low certainty). Variability in reporting adverse outcomes (e.g., gastrointestinal bleeding, acute kidney injury) precluded their meta-analysis.
In postoperative critical care adult patients, systemic NSAIDs reduced opioid use and probably reduced pain scores. However, the evidence is uncertain for the duration of mechanical ventilation or ICU length of stay. Further research is required to characterize the prevalence of NSAID-related adverse outcomes.
虽然阿片类药物是重症监护病房（ICU）常规镇痛治疗的一部分，但人们对其过度使用存在担忧。这是一项关于非甾体抗炎药（NSAIDs）在术后重症监护成年患者中使用情况的系统评价。
我们检索了截至2023年3月的医学文献分析与检索系统在线数据库（MEDLINE）、医学文摘数据库（EMBASE）、护理学与健康相关文献累积索引数据库（CINAHL）、考克兰图书馆、试验注册库、谷歌学术以及相关的系统评价。
两名研究者独立且重复地对标题、摘要和全文进行审查，以确定符合条件的研究。我们纳入了比较单独使用NSAIDs或作为阿片类药物辅助用于全身镇痛的随机对照试验（RCTs）。主要结局是阿片类药物的使用情况。
研究者使用预定义的提取表格，独立且重复地提取研究特征、患者人口统计学信息、干预细节以及感兴趣的结局。使用Review Manager软件5.4版（丹麦哥本哈根考克兰协作网）进行统计分析。
我们纳入了15项RCTs（n = 1,621例患者），这些患者因择期手术后的管理而入住ICU。阿片类药物联合NSAIDs治疗使24小时口服吗啡当量消耗量减少了21.4毫克（95%CI，减少11.8 - 31.0毫克；高确定性），并且可能使疼痛评分（通过视觉模拟量表测量）降低了6.1毫米（95%CI，降低12.2至增加0.1；中等确定性）。阿片类药物联合NSAIDs治疗可能对机械通气时间没有影响（减少1.6小时；95%CI，减少0.4小时至减少2.7小时；中等确定性），并且可能对ICU住院时间没有影响（减少2.1小时；95%CI，减少6.小时至增加2.0小时；低确定性）。不良结局（如胃肠道出血、急性肾损伤）报告的变异性使得无法对其进行荟萃分析。
在术后重症监护成年患者中，全身使用NSAIDs可减少阿片类药物的使用，并可能降低疼痛评分。然而，关于机械通气时间或ICU住院时间的证据尚不确定。需要进一步研究以明确NSAIDs相关不良结局的发生率。
