Chung Joohyun, Tjia Jennifer, Zhang Ning, O'Connor Brendan T
Dimens Crit Care Nurs. 2023;42(6):310-318. doi: 10.1097/DCC.0000000000000606.
Although previous studies have established the association of medications with anticholinergic adverse effects and xerostomia, anticholinergic burden and xerostomia in critical care settings are poorly characterized. The objective of this study was to determine the impact of medication burdens associated with anticholinergic adverse effects, particularly the occurrence of xerostomia (dry mouth) in a critical care setting. In addition, this study explored the correlation between the timing of the first instance of xerostomia and the administration timing of medication known to have anticholinergic adverse effects.
A retrospective case-control study was used with the MIMIC (Medical Information Mart for Intensive Care) III database. The MIMIC-III clinical database is a publicly available, deidentified, health-related database with more than 40 000 patients in critical care units from 2001 to 2012. Cases of xerostomia (n = 1344) were selected from clinical notes reporting "dry mouth," "xerostomia," or evidence of pharmacological treatment for xerostomia; control (n = 4032) was selected using the propensity analysis with 1:3 matching on covariates (eg, age, sex, race, ethnicity, and length of stay). The anticholinergic burden was quantified as the cumulative effect of anticholinergic activities using the Anticholinergic Burden Scale.
Anticholinergic burden significantly differed between xerostomia patients and control subjects (P = .04). The length of stay was a statistically significant factor in xerostomia. The probability of developing the symptom of xerostomia within 24 hours was .95 (95%) for patients of xerostomia.
Anticholinergic Burden Scale is associated with xerostomia in the critical care setting, particularly within 24 hours after admission. It is crucial to carefully evaluate alternative options for medications that may have potential anticholinergic adverse effects. This evaluation should include assessing the balance between the benefits and harms, considering the probability of withdrawal reactions, and prioritizing deprescribing whenever feasible within the initial 24-hour period.
尽管先前的研究已证实药物与抗胆碱能不良反应及口干之间存在关联，但重症监护环境中的抗胆碱能负担和口干情况仍未得到充分描述。本研究的目的是确定与抗胆碱能不良反应相关的药物负担的影响，尤其是重症监护环境中口干（口腔干燥）的发生情况。此外，本研究还探讨了口干首次出现的时间与已知具有抗胆碱能不良反应的药物给药时间之间的相关性。
使用MIMIC（重症监护医学信息集市）III数据库进行回顾性病例对照研究。MIMIC-III临床数据库是一个公开可用的、经过去识别处理的、与健康相关的数据库，包含2001年至2012年重症监护病房的40000多名患者。从报告“口干”“口腔干燥”或口干药物治疗证据的临床记录中选取口干病例（n = 1344）；使用倾向分析，按协变量（如年龄、性别、种族、民族和住院时间）1:3匹配选取对照（n = 4032）。使用抗胆碱能负担量表将抗胆碱能负担量化为抗胆碱能活性的累积效应。
口干患者与对照受试者的抗胆碱能负担存在显著差异（P = .04）。住院时间是口干的一个具有统计学意义的因素。口干患者在24小时内出现口干症状的概率为.95（95%）。
抗胆碱能负担量表与重症监护环境中的口干相关，尤其是在入院后24小时内。仔细评估可能具有潜在抗胆碱能不良反应的药物的替代选择至关重要。这种评估应包括评估利弊平衡、考虑撤药反应的可能性，并在最初的24小时内尽可能优先考虑停用药物。
