芬太尼与吗啡镇痛的住院和长期阿片类药物使用情况:ANALGESIC 试验结果

IF 1.4 4区 医学 Q3 CRITICAL CARE MEDICINE Critical Care and Resuscitation Pub Date : 2024-03-01 DOI:10.1016/j.ccrj.2023.11.004
Andrew Casamento MBBS, FACEM, FCICM , Angajendra Ghosh MBBS, FACEM, FCICM , Victor Hui MBBS, FANZCA , Ary Serpa Neto PhD, FCICM
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引用次数: 0

摘要

目标类阿片使用障碍极为常见。许多长期阿片类药物使用者都是在医院首次接触阿片类药物。我们旨在比较接受芬太尼与吗啡镇痛的患者长期使用阿片类药物的情况,并评估ICU中长期使用阿片类药物的相关风险因素。设计我们对 "重症监护中阿片类药物镇痛效果和镇静作用评估"(ANALGESIC)分组随机交叉试验进行了事后分析,该试验对机械通气患者进行芬太尼和吗啡输注镇痛。主要结果测量我们根据用于镇痛的药物评估了入院时未使用过阿片类药物的患者的出院情况和长期(90-365 天)阿片类药物使用情况。接受芬太尼治疗的患者与接受吗啡治疗的患者在出院时(16.5% 对 14.0%,P = 0.45)、出院后 90-180 天(3.7% 对 2.1%,P = 0.30)或出院后 180-365 天(3.4% 对 1.3%,P = 0.22)使用阿片类药物的情况没有差异。手术诊断和一种慢性疾病与阿片类药物出院处方的增加有关,而APACHE II评分的增加与出院处方的减少有关。结论在重症监护室接受机械通气镇痛治疗的阿片类药物无效患者中,约有七分之一的患者在出院时会被处方阿片类药物。使用芬太尼还是吗啡进行镇痛,出院处方和长期使用阿片类药物的情况没有差异。
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Hospital and long-term opioid use according to analgosedation with fentanyl vs. morphine: Findings from the ANALGESIC trial

Objectives

Opioid use disorder is extremely common. Many long-term opioid users will have their first exposure to opioids in hospitals. We aimed to compare long-term opioid use in patients who received fentanyl vs. morphine analgosedation and assess ICU related risk factors for long-term opioid use.

Design

We performed a post-hoc analysis of the Assessment of Opioid Administration to Lead to Analgesic Effects and Sedation in Intensive Care (ANALGESIC) cluster randomised crossover trial of fentanyl and morphine infusions for analgosedation in mechanically ventilated patients.

Setting

Two mixed, adult, university affiliated intensive care units in Melbourne, Australia.

Participants

Adult patients who were mechanically ventilated and received fentanyl or morphine for analgosedation in the ANALGESIC trial.

Main outcome measures

We assessed discharge and long-term (90–365 days) opioid use in opioid-naïve patients at hospital admission according to the agent used for analgosedation.

Results

We studied 477 patients (242 fentanyl and 235 morphine). There were no differences between discharge (16.5% vs. 14.0%, p = 0.45), 90–180 day post-discharge use (3.7% vs 2.1%, p = 0.30) or 180–365 day post-discharge use (3.4% vs 1.3%, p = 0.22) of opioids when comparing those patients who received fentanyl vs. those who received morphine. Surgical diagnosis and one chronic condition were associated with increased hospital discharge prescription of opioids, whereas increasing APACHE II score was associated with decreased discharge prescription. No ICU-related factors were associated with long-term opioid use.

Conclusions

Approximately one in seven opioid-naïve patients who receive analgosedation for mechanical ventilation in ICU will be prescribed opioid medications at hospital discharge. There was no difference in discharge prescription or long-term use of opioids depending on whether fentanyl or morphine was used for analgosedation.

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来源期刊
Critical Care and Resuscitation
Critical Care and Resuscitation CRITICAL CARE MEDICINE-
CiteScore
7.70
自引率
3.40%
发文量
44
审稿时长
>12 weeks
期刊介绍: ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines. The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world. The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.
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