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Characteristics associated with analgesia ordering in the intensive care unit and relationships with outcome
Amado X Freire1, Bekele Afessa, Pauline Cawley
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Tennessee Health Sciences Center, Memphis 38163, USA. afreire@utmem.edu
Objective:
To describe clinical characteristics associated with analgesia utilization in the intensive care unit.
Design:
A prospective cohort study of adult patients admitted to a medical intensive care unit.
Subjects:
Four hundred adult patients.
Setting:
Twelve-bed medical intensive care unit of an inner-city, university-affiliated hospital.
Measurements And Main Results:
Collected data included demographics, sedation and neuromuscular blocking agents used, mechanical ventilation, hemodynamic monitoring, Therapeutic Intervention Scoring System score, Logistic Organ Dysfunction System (LODS) score, and Acute Physiology and Chronic Health Evaluation (APACHE) II score. Hospital outcome was noted. The odds ratio and 95% confidence intervals were determined by using multiple logistic regression analyses. Patients' mean age (+/-sd) was 47.8 +/- 17.1 yrs; 58% were male, 84% African-American. Their APACHE II-predicted hospital mortality rate was 33%. Analgesics were used in 36% of patients. There were no differences in demographics, initial LODS score, APACHE II score, and mechanical ventilation use between patients who did and did not receive analgesics. Multiple logistic regression analysis showed that analgesic use was independently associated with sedation (odds ratio, 2.47; 95% confidence interval, 1.47-4.14), neuromuscular blockade (odds ratio, 4.98; 95% confidence interval, 1.85-13.41), and pulmonary artery flotation catheter utilization (odds ratio, 2.31; 95% confidence interval, 1.27-4.20). The median duration of mechanical ventilation was 5 days for those who received analgesia compared with 2 for those who did not (p =.0001). The median length of stay in the intensive care unit (4 vs. 2, p <.0001) and hospital (11 vs. 7, p <.0001) was higher in patients who received analgesics. There were no significant differences in intensive care unit and hospital mortality rates between patients who did and did not receive analgesics.
Conclusions:
Intensive care unit patients for whom analgesics were prescribed have a higher frequency of hemodynamic monitoring and use of sedative and neuromuscular blocking agents, more mechanical ventilation days, and longer intensive care unit and hospital lengths of stay.