Use of Opioids in the Medical Intensive Care Unit Is Not Associated with Outpatient Opiate Use

Chen, A.; Pang, Bob; Chowdhury, A.; Duggal, Abhijit

doi:10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a4135

Cited by 2 publications

(6 citation statements)

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“…21,32,33 More recently, however, the daily dose of fentanyl in ventilated patients receiving an opioid was 148.5 mg oMEDD. 34 Further studies are needed to determine whether lower opioid doses are more prevalent since the release of recent guidelines 10 advocating the lowest possible dose of opioid to achieve adequate analgesia.…”

Section: Characteristics Of Opioid Use In the Intensive Care Unitmentioning

confidence: 99%

“…The incidence of chronic post-ICU opioid use ranges from 2.6% to 16.3% in patients who were opioid-naive prior to ICU admission. 1,34,70 –72,74 –79 Trials with a larger incidence of persistent opioid use used a definition of single prescriptions of opioids. Using a time-based prescription of 120 days of opioid supply within the first year after ICU hospitalisation, Wunsch et al.…”

Section: Long-term Adverse Effects Of Opioids In the Intensive Care Unitmentioning

confidence: 99%

“…The few studies that have investigated this all used a definition of a single prescription, rather than a time-based definition of chronic opioid therapy. 34,70,78 As there is no consensus definition of chronic opioid therapy, it is a difficult endpoint to study. In addition, the exposure of opioid dose was a cumulative dose for the entire ICU admission, which ignores the varying nature of opioid exposure and confounders.…”

Section: Long-term Adverse Effects Of Opioids In the Intensive Care Unitmentioning

confidence: 99%

“…Several studies of varying ICU cohorts have analysed the incidence and potential causative factors associated with persistent opioid use after the ICU. 1,34,[69][70][71][72][73][74][75][76][77][78][79] Overall, the incidence of persistent opioid use after the ICU ranges from 2.6% to 70%. This observed variability is due to the inclusion of patients with preexisting opioid use, variable time to follow-up, differing definitions of chronic opioid therapy and the patient cohort being studied.…”

Section: Persistent Opioid Use After the Intensive Care Unitmentioning

confidence: 99%

“…The incidence of chronic post-ICU opioid use ranges from 2.6% to 16.3% in patients who were opioid-naive prior to ICU admission. 1,34,[70][71][72][74][75][76][77][78][79] Trials with a larger incidence of persistent opioid use used a definition of single prescriptions of opioids. Using a timebased prescription of 120 days of opioid supply within the first year after ICU hospitalisation, Wunsch et al reported the incidence of chronic opioid therapy in ICU patients receiving mechanical ventilation to be 2.6%, 1 with prescriptions occurring more in surgical patients than medical patients (4.1% versus 1.6% at 12 months).…”

Section: Persistent Opioid Use After the Intensive Care Unitmentioning

confidence: 99%

See 4 more Smart Citations

The complications of opioid use during and post–intensive care admission: A narrative review

Moran

Myburgh

Scott

2022

Anaesth Intensive Care

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Opioids are a commonly administered analgesic medication in the intensive care unit, primarily to facilitate invasive mechanical ventilation. Consensus guidelines advocate for an opioid-first strategy for the management of acute pain in ventilated patients. As a result, these patients are potentially exposed to high opioid doses for prolonged periods, increasing the risk of adverse effects. Adverse effects relevant to these critically ill patients include delirium, intensive care unit–acquired infections, acute opioid tolerance, iatrogenic withdrawal syndrome, opioid-induced hyperalgesia, persistent opioid use, and chronic post–intensive care unit pain. Consequently, there is a challenge of optimising analgesia while minimising these adverse effects. This narrative review will discuss the characteristics of opioid use in the intensive care unit, outline the potential short-term and long-term adverse effects of opioid therapy in critically ill patients, and outline a multifaceted strategy for opioid minimisation.

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Section: Characteristics Of Opioid Use In the Intensive Care Unitmentioning

confidence: 99%

Section: Long-term Adverse Effects Of Opioids In the Intensive Care Unitmentioning

confidence: 99%

Section: Long-term Adverse Effects Of Opioids In the Intensive Care Unitmentioning

confidence: 99%

Section: Persistent Opioid Use After the Intensive Care Unitmentioning

confidence: 99%

Section: Persistent Opioid Use After the Intensive Care Unitmentioning

confidence: 99%

See 3 more Smart Citations

The complications of opioid use during and post–intensive care admission: A narrative review

Moran

Myburgh

Scott

2022

Anaesth Intensive Care

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Opioid use following cardio-thoracic intensive care: risk factors and outcomes: a cohort study

von Oelreich,

Campoccia Jalde,

Rysz

et al. 2024

Sci Rep

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Opioid misuse has become a serious public health problem. Patients admitted to cardio-thoracic critical care are usually exposed to opioids, but the incidence and effects of chronic opioid use are not known. The primary objective was to describe opioid use after admission to a cardio-thoracic intensive care unit. Secondary objectives were to identify factors associated with chronic opioid usage and analyze risk of death. This cohort study included all cardio-thoracic ICU care episodes in Sweden between 2010 and 2018. Among the 34,200 patients included in the final study cohort, 4050 developed persistent opioid use after ICU care. Younger age, preadmission opioid use, female sex, presence of comorbidities and earlier year of ICU admission were all found to be associated with persistent opioid use. The adjusted hazard ratio for mortality between 6 and 18 months after admission among individuals with persistent opioid use was 2.2 (95% CI 1.8–2.6; P < 0.001). For opioid-naïve patients before ICU admission, new onset of chronic opioid usage was significant during the follow-up period of 24 months. Despite the absence of conclusive evidence supporting extended opioid treatment, the average opioid consumption remains notably elevated twelve months subsequent to cardio-thoracic ICU care.

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Use of Opioids in the Medical Intensive Care Unit Is Not Associated with Outpatient Opiate Use

Cited by 2 publications

References 0 publications

The complications of opioid use during and post–intensive care admission: A narrative review

The complications of opioid use during and post–intensive care admission: A narrative review

Opioid use following cardio-thoracic intensive care: risk factors and outcomes: a cohort study

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