We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Intravenous Opioid Administration During Mechanical Ventilation and Use After Hospital Discharge.
- Authors
Myers, Laura C.; Soltesz, Lauren; Bosch, Nicholas; Daly, Kathleen A.; Devis, Ycar; Rucci, Justin; Stevens, Jennifer; Wunsch, Hannah; Jafarzadeh, S. Reza; Campbell, Cynthia I.; Liu, Vincent X.; Walkey, Allan J.
- Abstract
Key Points: Question: Are the administration of intravenous opioids during mechanical ventilation and the dose given associated with opioid use following hospitalization in medical (nonsurgical) patients? Findings: In this cohort study of 6746 critically ill patients who received mechanical ventilation across 21 hospitals, patients receiving higher doses of intravenous opioids during mechanical ventilation had significantly increased risks of posthospitalization opioid use. Meaning: The findings of this study suggest that intravenous opioids administered during critical illness may be associated with opioid use after hospital discharge and that additional studies of intensive care unit opioid stewardship are needed. Importance: Guidelines recommend an analgesia-first strategy for sedation during mechanical ventilation, but associations between opioids provided during mechanical ventilation and posthospitalization opioid–related outcomes are unclear. Objective: To evaluate associations between an intravenous opioid dose received during mechanical ventilation and postdischarge opioid–related outcomes in medical (nonsurgical) patients. Design, Setting, and Participants: This retrospective cohort study evaluated adults receiving mechanical ventilation lasting 24 hours or more for acute respiratory failure and surviving hospitalization. Participants from 21 Kaiser Permanente Northern California hospitals from January 1, 2012, to December 31, 2019, were included. Data were analyzed from October 1, 2020, to October 31, 2023. Exposures: Terciles of median daily intravenous fentanyl equivalents during mechanical ventilation. Main Outcomes and Measures: The primary outcome was the first filled opioid prescription in 1 year after discharge. Secondary outcomes included persistent opioid use and opioid-associated complications. Secondary analyses tested for interaction between opioid doses during mechanical ventilation, prior opioid use, and posthospitalization opioid use. Estimates were based on multivariable-adjusted time-to-event analyses, with death as a competing risk, and censored for hospice or palliative care referral, rehospitalization with receipt of opioid, or loss of Kaiser Permanente plan membership. Results: The study included 6746 patients across 21 hospitals (median age, 67 years [IQR, 57-76 years]; 53.0% male). Of the participants, 3114 (46.2%) filled an opioid prescription in the year prior to admission. The median daily fentanyl equivalent during mechanical ventilation was 200 μg (IQR, 40-1000 μg), with terciles of 0 to 67 μg, more than 67 to 700 μg, and more than 700 μg. Compared with patients who did not receive opioids during mechanical ventilation (n = 1013), a higher daily opioid dose was associated with opioid prescriptions in the year after discharge (n = 2942 outcomes; tercile 1: adjusted hazard ratio [AHR], 1.00 [95% CI, 0.85-1.17], tercile 2: AHR, 1.20 [95% CI, 1.03-1.40], and tercile 3: AHR, 1.25 [95% CI, 1.07-1.47]). Higher doses of opioids during mechanical ventilation were also associated with persistent opioid use after hospitalization (n = 1410 outcomes; tercile 3 vs no opioids: odds ratio, 1.44 [95% CI, 1.14-1.83]). No interaction was observed between opioid dose during mechanical ventilation, prior opioid use, and posthospitalization opioid use. Conclusions and Relevance: In this retrospective cohort study of patients receiving mechanical ventilation, opioids administered during mechanical ventilation were associated with opioid prescriptions following hospital discharge. Additional studies to evaluate risks and benefits of strategies using lower opioid doses are warranted. This cohort study evaluates whether intravenous opioids administered during mechanical ventilation are associated with opioid use following hospital discharge among medical (nonsurgical) patients.
- Subjects
CALIFORNIA; SECONDARY analysis; RESEARCH funding; HOSPITAL care; DISCHARGE planning; TREATMENT effectiveness; RETROSPECTIVE studies; MULTIVARIATE analysis; DESCRIPTIVE statistics; INTRAVENOUS therapy; LONGITUDINAL method; ODDS ratio; OPIOID analgesics; ARTIFICIAL respiration; MEDICAL records; ACQUISITION of data; DRUG interactions; INTENSIVE care units; COMPARATIVE studies; CONFIDENCE intervals; DRUGSTORES; FENTANYL; PROPORTIONAL hazards models
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2417292
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.17292