Implications of opioid-sparing medications in critically ill patients: A scoping review

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE Medicina Intensiva Pub Date : 2024-11-26 DOI:10.1016/j.medin.2024.06.001

Gabriella Gambadoro , Brian J. Kopp , Brian L. Erstad

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Abstract

Objective

The purpose of this scoping review was to evaluate literature involving opioid-sparing medications in critically ill patients with a focus on clinically meaningful outcomes.

Design

Scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Setting

Intensive care unit.

Patients or participants

Adult patients in an intensive care unit setting.

Interventions

None.

Main variables of interest

PubMed and Cochrane Library were searched from October 1, 2019 to June 1, 2023. Inclusion criteria consisted of randomized controlled trials evaluating adjunctive analgesic use in adult patients in an intensive care unit setting.

Results

There were 343 citations and titles identified in the initial search, with 328 remaining after removal of duplicates, 294 excluded at title and abstract screening, 34 available for full text review, and six included in the scoping review. Most studies reported modest reductions in opioid use as a secondary endpoint. Improvement in clinical outcomes such as reduction in duration of mechanical ventilation or delirium were reported in two trials with dexmedetomidine.

Conclusions

In recently published trials of adjunctive agents in critically ill patients, opioid-sparing effects were small. Data to support improvements in clinical outcomes remains limited.

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重症患者使用阿片类药物的意义：范围综述

目的本范围界定综述的目的是评估重症患者使用阿片类药物的文献，重点关注有临床意义的结果.设计范围界定综述采用范围界定综述的系统综述和Meta分析首选报告项目.设置重症监护病房.患者或参与者重症监护病房的成年患者.干预措施无.主要关注变量检索了2019年10月1日至2023年6月1日期间的PubMed和Cochrane图书馆。纳入标准包括评估重症监护室环境中成年患者辅助镇痛剂使用情况的随机对照试验。结果初步检索共发现 343 篇引文和标题，去除重复内容后剩余 328 篇，标题和摘要筛选排除了 294 篇，34 篇可供全文审阅，6 篇纳入了范围界定综述。大多数研究将阿片类药物使用量的适度减少作为次要终点。结论在最近发表的重症患者辅助用药试验中，阿片类药物的节省效果很小。结论在最近发表的重症患者辅助用药试验中，阿片类药物的节省效果很小，支持临床效果改善的数据仍然有限。

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来源期刊

Medicina Intensiva CRITICAL CARE MEDICINE-

CiteScore

2.70

自引率

20.00%

发文量

146

审稿时长

33 days

期刊介绍： Medicina Intensiva is the journal of the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC) and of Pan American and Iberian Federation of Societies of Intensive and Critical Care Medicine. Medicina Intensiva has become the reference publication in Spanish in its field. The journal mainly publishes Original Articles, Reviews, Clinical Notes, Consensus Documents, Images, and other information relevant to the specialty. All works go through a rigorous selection process. The journal accepts submissions of articles in English and in Spanish languages. The journal follows the publication requirements of the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE).