Risk Factors for Increased Opioid Use During Postoperative Intensive Care.

Q4 Medicine
Critical care explorations Pub Date : 2024-10-25 eCollection Date: 2024-11-01 DOI:10.1097/CCE.0000000000001172
Lauriane Guichard, Milo C Engoren, Yi-Ju Li, Matthew J Sigakis, Xinming An, Chad M Brummett, Matthew C Mauck, Karthik Raghunathan, Daniel J Clauw, Vijay Krishnamoorthy
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引用次数: 0

Abstract

Importance: In the ICU, opioids treat pain and improve ventilator tolerance as part of an analgosedation approach. Identifying predictors of opioid consumption during the ICU course might highlight actionable items to reduce opioid consumption.

Objectives: To identify risk factors for opioid use during a postoperative ICU course.

Design, setting, and participants: Patients enrolled in the Michigan Genomics Initiative single-center prospective observational cohort study completed baseline preoperative sociodemographic and mental/physical health questionnaires and provided blood samples for genetic analysis. Included patients were 18 years old and older, admitted to ICU postoperatively, and received opioids postoperatively.

Main outcomes and measures: The primary outcome was ICU mean daily oral morphine equivalent (OME) use. The association between OME and phenotypic risk factors and genetic variants previously associated with pain were analyzed through univariable and multivariable linear regression models.

Results: The cohort consisted of 1865 mixed-surgical patients with mean age of 56 years (sd, 15 yr). Preoperative opioid users were more likely to continue to receive opioids throughout their ICU stay than opioid-naive patients. OME (log10 scale) was most strongly associated with ICU mechanical ventilation (β = 0.27; 95% CI, 0.15-0.38; p < 0.0001; effect size 1.85 for receiving > 24 hours of mechanical ventilation), preoperative opioid use (β = 0.22; 95% CI, 0.16-0.29; p < 0.0001; effect size 1.67 for receiving preoperative opioids), major surgery (β = 0.21; 95% CI, 0.12-0.30; p < 0.0001; effect size 1.62 compared with minor surgery), and current/former illicit drug use (β = 0.12; 95% CI, 0.01-0.23; p = 0.04; effect size 1.30 for drug use). Younger age, centralized pain, and longer anesthetic duration were also significantly associated with OME but with smaller effect sizes. Selected genetic variants (FKBP5, COMT, and OPRM1) were not associated with OME use.

Conclusions and relevance: Mechanical ventilation and preoperative opioids were the strongest risk factors for postoperative ICU opioid consumption, whereas psychologic factors and genetic variants were not associated.

术后重症监护期间阿片类药物使用增加的风险因素。
重要性:在重症监护室,阿片类药物可治疗疼痛并改善呼吸机耐受性,是镇痛方法的一部分。确定重症监护室病程中阿片类药物消耗的预测因素可突出减少阿片类药物消耗的可行项目:确定术后重症监护室病程中阿片类药物使用的风险因素:密歇根基因组学倡议"(Michigan Genomics Initiative)单中心前瞻性观察队列研究的入组患者填写了术前社会人口学和心理/生理健康基线问卷,并提供了用于基因分析的血液样本。纳入研究的患者年龄在 18 岁及以上,术后入住 ICU,术后接受阿片类药物治疗:主要结果和测量指标:主要结果是重症监护室平均每日口服吗啡当量(OME)的使用量。通过单变量和多变量线性回归模型分析了OME与表型风险因素以及之前与疼痛相关的基因变异之间的关系:队列由 1865 名混合手术患者组成,平均年龄为 56 岁(sd,15 岁)。与未使用阿片类药物的患者相比,术前使用阿片类药物的患者更有可能在整个重症监护室住院期间继续接受阿片类药物治疗。OME(log10标度)与ICU机械通气(β = 0.27; 95% CI, 0.15-0.38; p < 0.0001; 接受> 24小时机械通气的效应大小为1.85)、术前阿片类药物使用(β = 0.22; 95% CI, 0.16-0.29; p < 0.0001;术前接受阿片类药物的效应大小为 1.67)、大手术(β = 0.21;95% CI,0.12-0.30;p < 0.0001;与小手术相比,效应大小为 1.62)以及当前/曾经使用非法药物(β = 0.12;95% CI,0.01-0.23;p = 0.04;使用药物的效应大小为 1.30)。年龄较小、疼痛集中和麻醉时间较长也与 OME 显著相关,但效应大小较小。某些基因变异(FKBP5、COMT 和 OPRM1)与 OME 的使用无关:机械通气和术前阿片类药物是 ICU 术后阿片类药物消耗的最大风险因素,而心理因素和基因变异则与之无关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.70
自引率
0.00%
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0
审稿时长
8 weeks
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