PDF(Pubmed)
Abstract：
OBJECTIVE: Exposure to critical illness and intensive care may lead to long-term psychologic and physical impairments. To what extent ICU survivors become prolonged users of benzodiazepines after exposure to critical care is not fully explored. This study aimed to describe the extent of onset of prolonged high-potency benzodiazepine use among ICU survivors not using these drugs before admission, identify factors associated with this use, and analyze whether such usage is associated with increased mortality.
METHODS: Retrospective cohort study.
METHODS: Sweden, including all registered ICU admissions between 2010 and 2017.
METHODS: ICU patients surviving for at least 3 months, not using high-potency benzodiazepine before admission, were eligible for inclusion.
METHODS: Admission to intensive care.
RESULTS: A total of 237,904 patients were screened and 137,647 were included. Of these 5338 (3.9%) became prolonged users of high-potency benzodiazepines after ICU discharge. A peak in high-potency benzodiazepine prescriptions was observed during the first 3 months, followed by sustained usage throughout the follow-up period of 18 months. Prolonged usage was associated with older age, female sex, and a history of both somatic and psychiatric comorbidities, including substance abuse. Additionally, a longer ICU stay, a high estimated mortality rate, and prior consumption of low-potency benzodiazepines were associated with prolonged use. The risk of death between 6 and 18 months post-ICU admission was significantly higher among high-potency benzodiazepine users, with an adjusted hazard ratio of 1.8 (95% CI, 1.7-2.0; p < 0.001). No differences were noted in causes of death between users and nonusers.
UNASSIGNED: Despite the lack of evidence supporting long-term treatment, prolonged usage of high-potency benzodiazepines 18 months following ICU care was notable and associated with an increased risk of death. Considering the substantial number of ICU admissions, prevention of benzodiazepine misuse may improve long-term outcomes following critical care.
METHODS: Retrospective cohort study.
METHODS: Sweden, including all registered ICU admissions between 2010 and 2017.
METHODS: ICU patients surviving for at least 3 months, not using high-potency benzodiazepine before admission, were eligible for inclusion.
METHODS: Admission to intensive care.
RESULTS: A total of 237,904 patients were screened and 137,647 were included. Of these 5338 (3.9%) became prolonged users of high-potency benzodiazepines after ICU discharge. A peak in high-potency benzodiazepine prescriptions was observed during the first 3 months, followed by sustained usage throughout the follow-up period of 18 months. Prolonged usage was associated with older age, female sex, and a history of both somatic and psychiatric comorbidities, including substance abuse. Additionally, a longer ICU stay, a high estimated mortality rate, and prior consumption of low-potency benzodiazepines were associated with prolonged use. The risk of death between 6 and 18 months post-ICU admission was significantly higher among high-potency benzodiazepine users, with an adjusted hazard ratio of 1.8 (95% CI, 1.7-2.0; p < 0.001). No differences were noted in causes of death between users and nonusers.
UNASSIGNED: Despite the lack of evidence supporting long-term treatment, prolonged usage of high-potency benzodiazepines 18 months following ICU care was notable and associated with an increased risk of death. Considering the substantial number of ICU admissions, prevention of benzodiazepine misuse may improve long-term outcomes following critical care.
摘要：
目的：危重病和重症监护可能导致长期的心理和身体损伤。ICU幸存者在暴露于重症监护后成为苯二氮卓类药物的长期使用者的程度尚未得到充分探讨。这项研究旨在描述ICU幸存者在入院前不使用这些药物的长期高效使用苯二氮卓类药物的发作程度。确定与此使用相关的因素，并分析此类使用是否与死亡率增加有关。
方法：回顾性队列研究。
方法：瑞典，包括2010年至2017年期间所有注册的ICU入院。
方法：ICU患者存活至少3个月，入院前不使用高效苯二氮卓类药物，有资格列入。
方法：接受重症监护。
结果：共筛查了237,904名患者，纳入了137,647名患者。在ICU出院后，这5338（3.9％）成为高效苯二氮卓类药物的长期使用者。在前3个月观察到高效苯二氮卓类药物处方的峰值，随后在整个18个月的随访期内持续使用。长期使用与年龄增长有关，女性性别,以及躯体和精神合并症的历史，包括药物滥用。此外,更久的住ICU,估计死亡率很高，和低效苯二氮卓类药物的先前消费与长期使用有关。入住ICU后6至18个月的死亡风险在高效苯二氮卓类药物使用者中明显更高，调整后的风险比为1.8（95%CI，1.7-2.0；p<0.001）。用户和非用户之间的死亡原因没有差异。
■尽管缺乏支持长期治疗的证据，ICU护理后18个月长时间使用高效苯二氮卓类药物是值得注意的,并且与死亡风险增加相关.考虑到重症监护病房的大量入院，预防苯二氮卓类药物误用可能改善重症监护后的长期结局.
方法：回顾性队列研究。
方法：瑞典，包括2010年至2017年期间所有注册的ICU入院。
方法：ICU患者存活至少3个月，入院前不使用高效苯二氮卓类药物，有资格列入。
方法：接受重症监护。
结果：共筛查了237,904名患者，纳入了137,647名患者。在ICU出院后，这5338（3.9％）成为高效苯二氮卓类药物的长期使用者。在前3个月观察到高效苯二氮卓类药物处方的峰值，随后在整个18个月的随访期内持续使用。长期使用与年龄增长有关，女性性别,以及躯体和精神合并症的历史，包括药物滥用。此外,更久的住ICU,估计死亡率很高，和低效苯二氮卓类药物的先前消费与长期使用有关。入住ICU后6至18个月的死亡风险在高效苯二氮卓类药物使用者中明显更高，调整后的风险比为1.8（95%CI，1.7-2.0；p<0.001）。用户和非用户之间的死亡原因没有差异。
■尽管缺乏支持长期治疗的证据，ICU护理后18个月长时间使用高效苯二氮卓类药物是值得注意的,并且与死亡风险增加相关.考虑到重症监护病房的大量入院，预防苯二氮卓类药物误用可能改善重症监护后的长期结局.
