Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, School of Medicine, Aurora, CO.
Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO.
Crit Care Med. 2024 Jul 1;52(7):1043-1053. doi: 10.1097/CCM.0000000000006253. Epub 2024 Mar 20.
To describe U.S. practice regarding administration of sedation and analgesia to patients on noninvasive ventilation (NIV) for acute respiratory failure (ARF) and to determine the association of this practice with odds of intubation or death.
A retrospective multicenter cohort study.
A total of 1017 hospitals contributed data between January 2010 and September 2020 to the Premier Healthcare Database, a nationally representative healthcare database in the United States.
Adult (≥ 18 yr) patients admitted to U.S. hospitals requiring NIV for ARF.
None.
We identified 433,357 patients on NIV of whom (26.7% [95% CI] 26.3%-27.0%) received sedation or analgesia. A total of 50,589 patients (11.7%) received opioids only, 40,646 (9.4%) received benzodiazepines only, 20,146 (4.6%) received opioids and benzodiazepines, 1.573 (0.4%) received dexmedetomidine only, and 2,639 (0.6%) received dexmedetomidine in addition to opioid and/or benzodiazepine. Of 433,357 patients receiving NIV, 50,413 (11.6%; 95% CI, 11.5-11.7%) patients underwent invasive mechanical ventilation on hospital days 2-5 or died on hospital days 2-30. Intubation was used in 32,301 patients (7.4%; 95% CI, 7.3-7.6%). Further, death occurred in 24,140 (5.6%; 95% CI, 5.5-5.7%). In multivariable analysis adjusting for relevant covariates, receipt of any medication studied was associated with increased odds of intubation or death. In inverse probability weighting, receipt of any study medication was also associated with increased odds of intubation or death (average treatment effect odds ratio 1.38; 95% CI, 1.35-1.40).
The use of sedation and analgesia during NIV is common. Medication exposure was associated with increased odds of intubation or death. Further investigation is needed to confirm this finding and determine whether any subpopulations are especially harmed by this practice.
描述美国对接受无创通气（NIV）治疗急性呼吸衰竭（ARF）患者进行镇静和镇痛管理的实践情况，并确定这种实践与插管或死亡的几率的关联。
回顾性多中心队列研究。
2010 年 1 月至 2020 年 9 月期间，总计 1017 家医院向美国 Premier Healthcare Database 提供了数据，该数据库是一个具有全国代表性的美国医疗保健数据库。
入住美国医院、需要接受 NIV 治疗 ARF 的成年（≥18 岁）患者。
无。
我们确定了 433357 名接受 NIV 的患者，其中（26.7% [95%CI] 26.3%-27.0%）接受了镇静或镇痛治疗。共有 50589 名患者（11.7%）仅接受阿片类药物治疗，40646 名患者（9.4%）仅接受苯二氮䓬类药物治疗，20146 名患者（4.6%）接受阿片类药物和苯二氮䓬类药物治疗，1573 名患者（0.4%）仅接受右美托咪定治疗，2639 名患者（0.6%）除了接受阿片类药物和/或苯二氮䓬类药物外，还接受了右美托咪定治疗。在接受 NIV 的 433357 名患者中，50413 名（11.6%；95%CI，11.5-11.7%）患者在医院第 2-5 天接受有创机械通气或在医院第 2-30 天死亡。32301 名患者（7.4%；95%CI，7.3-7.6%）接受了插管。此外，24140 名患者（5.6%；95%CI，5.5-5.7%）死亡。在调整相关协变量的多变量分析中，接受任何研究药物治疗与插管或死亡的几率增加相关。在逆概率加权中，接受任何研究药物治疗也与插管或死亡的几率增加相关（平均治疗效果比值比 1.38；95%CI，1.35-1.40）。
在 NIV 期间使用镇静和镇痛很常见。药物暴露与插管或死亡的几率增加相关。需要进一步调查以证实这一发现，并确定是否有任何亚组人群特别受到这种做法的影响。
