PDF(Pubmed)
Abstract：
UNASSIGNED: Guidelines recommend an analgesia-first strategy for sedation during mechanical ventilation, but associations between opioids provided during mechanical ventilation and posthospitalization opioid-related outcomes are unclear.
UNASSIGNED: To evaluate associations between an intravenous opioid dose received during mechanical ventilation and postdischarge opioid-related outcomes in medical (nonsurgical) patients.
UNASSIGNED: This retrospective cohort study evaluated adults receiving mechanical ventilation lasting 24 hours or more for acute respiratory failure and surviving hospitalization. Participants from 21 Kaiser Permanente Northern California hospitals from January 1, 2012, to December 31, 2019, were included. Data were analyzed from October 1, 2020, to October 31, 2023.
UNASSIGNED: Terciles of median daily intravenous fentanyl equivalents during mechanical ventilation.
UNASSIGNED: The primary outcome was the first filled opioid prescription in 1 year after discharge. Secondary outcomes included persistent opioid use and opioid-associated complications. Secondary analyses tested for interaction between opioid doses during mechanical ventilation, prior opioid use, and posthospitalization opioid use. Estimates were based on multivariable-adjusted time-to-event analyses, with death as a competing risk, and censored for hospice or palliative care referral, rehospitalization with receipt of opioid, or loss of Kaiser Permanente plan membership.
UNASSIGNED: The study included 6746 patients across 21 hospitals (median age, 67 years [IQR, 57-76 years]; 53.0% male). Of the participants, 3114 (46.2%) filled an opioid prescription in the year prior to admission. The median daily fentanyl equivalent during mechanical ventilation was 200 μg (IQR, 40-1000 μg), with terciles of 0 to 67 μg, more than 67 to 700 μg, and more than 700 μg. Compared with patients who did not receive opioids during mechanical ventilation (n = 1013), a higher daily opioid dose was associated with opioid prescriptions in the year after discharge (n = 2942 outcomes; tercile 1: adjusted hazard ratio [AHR], 1.00 [95% CI, 0.85-1.17], tercile 2: AHR, 1.20 [95% CI, 1.03-1.40], and tercile 3: AHR, 1.25 [95% CI, 1.07-1.47]). Higher doses of opioids during mechanical ventilation were also associated with persistent opioid use after hospitalization (n = 1410 outcomes; tercile 3 vs no opioids: odds ratio, 1.44 [95% CI, 1.14-1.83]). No interaction was observed between opioid dose during mechanical ventilation, prior opioid use, and posthospitalization opioid use.
UNASSIGNED: In this retrospective cohort study of patients receiving mechanical ventilation, opioids administered during mechanical ventilation were associated with opioid prescriptions following hospital discharge. Additional studies to evaluate risks and benefits of strategies using lower opioid doses are warranted.
UNASSIGNED: To evaluate associations between an intravenous opioid dose received during mechanical ventilation and postdischarge opioid-related outcomes in medical (nonsurgical) patients.
UNASSIGNED: This retrospective cohort study evaluated adults receiving mechanical ventilation lasting 24 hours or more for acute respiratory failure and surviving hospitalization. Participants from 21 Kaiser Permanente Northern California hospitals from January 1, 2012, to December 31, 2019, were included. Data were analyzed from October 1, 2020, to October 31, 2023.
UNASSIGNED: Terciles of median daily intravenous fentanyl equivalents during mechanical ventilation.
UNASSIGNED: The primary outcome was the first filled opioid prescription in 1 year after discharge. Secondary outcomes included persistent opioid use and opioid-associated complications. Secondary analyses tested for interaction between opioid doses during mechanical ventilation, prior opioid use, and posthospitalization opioid use. Estimates were based on multivariable-adjusted time-to-event analyses, with death as a competing risk, and censored for hospice or palliative care referral, rehospitalization with receipt of opioid, or loss of Kaiser Permanente plan membership.
UNASSIGNED: The study included 6746 patients across 21 hospitals (median age, 67 years [IQR, 57-76 years]; 53.0% male). Of the participants, 3114 (46.2%) filled an opioid prescription in the year prior to admission. The median daily fentanyl equivalent during mechanical ventilation was 200 μg (IQR, 40-1000 μg), with terciles of 0 to 67 μg, more than 67 to 700 μg, and more than 700 μg. Compared with patients who did not receive opioids during mechanical ventilation (n = 1013), a higher daily opioid dose was associated with opioid prescriptions in the year after discharge (n = 2942 outcomes; tercile 1: adjusted hazard ratio [AHR], 1.00 [95% CI, 0.85-1.17], tercile 2: AHR, 1.20 [95% CI, 1.03-1.40], and tercile 3: AHR, 1.25 [95% CI, 1.07-1.47]). Higher doses of opioids during mechanical ventilation were also associated with persistent opioid use after hospitalization (n = 1410 outcomes; tercile 3 vs no opioids: odds ratio, 1.44 [95% CI, 1.14-1.83]). No interaction was observed between opioid dose during mechanical ventilation, prior opioid use, and posthospitalization opioid use.
UNASSIGNED: In this retrospective cohort study of patients receiving mechanical ventilation, opioids administered during mechanical ventilation were associated with opioid prescriptions following hospital discharge. Additional studies to evaluate risks and benefits of strategies using lower opioid doses are warranted.
摘要：
■指南建议在机械通气期间采用镇痛优先的镇静策略，但目前尚不清楚机械通气期间提供的阿片类药物与注射后阿片类药物相关结局之间的关联.
■评估内科（非手术）患者在机械通气期间接受静脉阿片类药物剂量与出院后阿片类药物相关结局之间的关联。
这项回顾性队列研究评估了接受机械通气持续24小时或更长时间的急性呼吸衰竭和住院存活的成年人。纳入了2012年1月1日至2019年12月31日来自北加州21家KaiserPermanente医院的参与者。数据从2020年10月1日至2023年10月31日进行了分析。
■机械通气期间每日静脉注射芬太尼当量的中位数。
■主要结果是出院后1年内首次服用阿片类药物处方。次要结果包括持续使用阿片类药物和阿片类药物相关并发症。二次分析在机械通气期间测试阿片类药物剂量之间的相互作用，以前使用阿片类药物，以及阿片类药物的使用。估计值基于多变量调整后的事件时间分析，死亡是一种相互竞争的风险，并审查临终关怀或姑息治疗转诊，接受阿片类药物再住院，或失去KaiserPermanente计划会员资格。
■该研究包括21家医院的6746名患者（中位年龄，67年[IQR，57-76岁]；53.0%男性）。在参与者中，3114（46.2％）在入院前一年填写了阿片类药物处方。机械通气期间每日芬太尼当量中位数为200μg(IQR，40-1000μg)，具有0至67μg的三角，超过67至700微克，超过700微克。与机械通气期间未接受阿片类药物的患者相比（n=1013），每日阿片类药物剂量较高与出院后一年的阿片类药物处方相关(n=2942个结局;时间1:调整后的风险比[AHR],1.00[95%CI，0.85-1.17]，第2期：AHR，1.20[95%CI，1.03-1.40]，第三部分:AHR，1.25[95%CI，1.07-1.47]）。机械通气期间较高剂量的阿片类药物也与住院后持续使用阿片类药物有关（n=1410结果；短期3与无阿片类药物：比值比，1.44[95%CI，1.14-1.83]）。在机械通气期间，未观察到阿片类药物剂量之间的相互作用，以前使用阿片类药物，以及阿片类药物的使用。
■在这项对机械通气患者的回顾性队列研究中，在机械通气期间使用阿片类药物与出院后的阿片类药物处方相关.需要进行其他研究以评估使用较低阿片类药物剂量的策略的风险和收益。
■评估内科（非手术）患者在机械通气期间接受静脉阿片类药物剂量与出院后阿片类药物相关结局之间的关联。
这项回顾性队列研究评估了接受机械通气持续24小时或更长时间的急性呼吸衰竭和住院存活的成年人。纳入了2012年1月1日至2019年12月31日来自北加州21家KaiserPermanente医院的参与者。数据从2020年10月1日至2023年10月31日进行了分析。
■机械通气期间每日静脉注射芬太尼当量的中位数。
■主要结果是出院后1年内首次服用阿片类药物处方。次要结果包括持续使用阿片类药物和阿片类药物相关并发症。二次分析在机械通气期间测试阿片类药物剂量之间的相互作用，以前使用阿片类药物，以及阿片类药物的使用。估计值基于多变量调整后的事件时间分析，死亡是一种相互竞争的风险，并审查临终关怀或姑息治疗转诊，接受阿片类药物再住院，或失去KaiserPermanente计划会员资格。
■该研究包括21家医院的6746名患者（中位年龄，67年[IQR，57-76岁]；53.0%男性）。在参与者中，3114（46.2％）在入院前一年填写了阿片类药物处方。机械通气期间每日芬太尼当量中位数为200μg(IQR，40-1000μg)，具有0至67μg的三角，超过67至700微克，超过700微克。与机械通气期间未接受阿片类药物的患者相比（n=1013），每日阿片类药物剂量较高与出院后一年的阿片类药物处方相关(n=2942个结局;时间1:调整后的风险比[AHR],1.00[95%CI，0.85-1.17]，第2期：AHR，1.20[95%CI，1.03-1.40]，第三部分:AHR，1.25[95%CI，1.07-1.47]）。机械通气期间较高剂量的阿片类药物也与住院后持续使用阿片类药物有关（n=1410结果；短期3与无阿片类药物：比值比，1.44[95%CI，1.14-1.83]）。在机械通气期间，未观察到阿片类药物剂量之间的相互作用，以前使用阿片类药物，以及阿片类药物的使用。
■在这项对机械通气患者的回顾性队列研究中，在机械通气期间使用阿片类药物与出院后的阿片类药物处方相关.需要进行其他研究以评估使用较低阿片类药物剂量的策略的风险和收益。
