虽然阿片类药物是ICU镇痛的常规护理的一部分,有人担心过度使用。这是对非甾体抗炎药(NSAIDs)在术后重症监护成人患者中使用的系统评价。
方法:我们在线搜索了医学文献分析和检索系统,摘录医疗数据库,护理和相关健康文献的累积指数,科克伦图书馆,审判登记处,谷歌学者,和相关的系统评价到2023年3月。
方法:标题,摘要,和全文由两名研究者独立审查并一式两份,以确定符合条件的研究.我们纳入了随机对照试验(RCTs),比较了NSAIDs单独或作为阿片类药物辅助全身镇痛的效果。主要结果是阿片类药物的利用。
方法:一式两份,研究者独立提取研究特征,患者人口统计学,干预细节,和使用预定义的抽象表单感兴趣的结果。使用ReviewManager软件版本5.4进行统计分析。(科克伦合作,哥本哈根,丹麦)。
结果:我们纳入了15项RCTs(n=1,621例患者),用于在择期手术后进入ICU进行术后管理。阿片类药物的辅助NSAID治疗可使24小时口服吗啡等效量减少21.4mg(95%CI,减少11.8-31.0mg;高确定性),并可能使疼痛评分(通过视觉模拟量表测量)减少6.1mm(95%CI,12.2降低至0.1增加;中等确定性)。辅助NSAID治疗可能对机械通气的持续时间没有影响(减少1.6小时;95%CI,减少0.4小时至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6.1小时至增加2.0小时;低确定性)。报告不良结果的可变性(例如,消化道出血,急性肾损伤)排除了他们的荟萃分析。
结论:在术后重症监护的成年患者中,全身性NSAIDs减少了阿片类药物的使用,并可能降低了疼痛评分.然而,机械通气持续时间或ICU住院时间的证据尚不确定.需要进一步的研究来表征NSAID相关不良结局的患病率。
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.
METHODS: 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.
METHODS: 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.
METHODS: 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).
RESULTS: We included 15 RCTs (n = 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.
CONCLUSIONS: 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.