The prescribing patterns and effectiveness of sedatives and analgesics for severe traumatic brain injury patients in Taiwan

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2025-04-25 DOI:10.1016/j.jcrc.2025.155094

Sui-Sum Kung , Shao-Yun Chien , Fen-Fen Liao , Yi-Hsin Yang , Kun-Pin Hsieh

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引用次数: 0

Abstract

Background

Traumatic brain injury (TBI) is a major global health challenge associated with high mortality and morbidity. Secondary brain injury caused by disrupted intracranial pressure (ICP) regulation often necessitates sedation; however, guidelines lack specificity for TBI management.

Methods

This study analyzed sedation and analgesia prescribing patterns and their outcomes in severe TBI patients in Taiwan using National Health Insurance Research Database data (2012–2019). Severe TBI patients intubated during intensive care unit (ICU) hospitalization were included. The primary outcome was 30-day all-cause mortality, with sensitivity analyses for 14-day mortality and 30-day all-cause mortality excluding deaths within 3 days. Inverse probability of treatment weighting (IPTW) was applied to balance patient characteristics across groups. Mortality rates across groups were evaluated using Kaplan-Meier survival analysis. At the same time, the Cox proportional hazards model simultaneously assessed the impact of various risk factors, such as age and comorbidities, on mortality.

Results

Among 6030 patients, sedation and analgesia patterns varied, with midazolam combined with opioids being the most common regimen. Compared to the reference group (sedatives with opioids), the risk of death was highest in the no-prescription group (HR = 2.73, 95 % CI = 2.60–2.86), followed by the sedation-only group (HR = 1.58, 95 % CI = 1.50–1.66) and the opioids-only group (HR = 1.49, 95 % CI = 1.42–1.57; all p < 0.0001). Sensitivity analyses confirmed consistent trends.

Conclusions

These findings underscore the importance of optimizing sedation practices and enhancing awareness to improve outcomes for severe TBI patients.

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台湾地区重型颅脑损伤患者镇静镇痛药处方及疗效分析

背景：外伤性脑损伤（TBI）是一项重大的全球健康挑战，与高死亡率和发病率相关。颅内压（ICP）调节中断引起的继发性脑损伤通常需要镇静治疗；然而，指南缺乏TBI管理的特异性。方法利用国民健康保险研究数据库（National Health Insurance Research Database） 2012-2019年数据，分析台湾地区重型颅脑损伤患者镇静镇痛处方模式及其疗效。重症监护病房（ICU）住院期间插管的严重TBI患者被纳入研究。主要终点为30天全因死亡率，并对14天死亡率和不包括3天内死亡的30天全因死亡率进行敏感性分析。应用治疗加权逆概率（IPTW）来平衡各组患者的特征。采用Kaplan-Meier生存分析评估各组死亡率。同时，Cox比例风险模型同时评估了年龄、合并症等各种危险因素对死亡率的影响。结果6030例患者镇静和镇痛模式各不相同，以咪达唑仑联合阿片类药物为最常见的方案。与参照组（含阿片类药物的镇静剂）相比，无处方组的死亡风险最高（HR = 2.73, 95% CI = 2.60-2.86），其次是仅使用镇静剂组（HR = 1.58, 95% CI = 1.50-1.66）和仅使用阿片类药物组(HR = 1.49, 95% CI = 1.42-1.57；所有p <；0.0001)。敏感性分析证实了一致的趋势。结论这些发现强调了优化镇静方法和提高镇静意识对改善重型颅脑损伤患者预后的重要性。

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

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.