Related Experiment Video

Updated: Jun 23, 2026

Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device

Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device

Published on: September 24, 2020

Remifentanil discontinuation and subsequent intensive care unit-acquired infection: a cohort study

Saad Nseir¹, Jérémy Hoel, Guillaume Grailles

¹Intensive Care Unit, Calmette Hospital, University Hospital of Lille, boulevard du Pr Leclercq, 59037 Lille cedex, France.

Critical Care (London, England)

|April 23, 2009

Abstract

Introduction:

Recent animal studies demonstrated immunosuppressive effects of opioid withdrawal resulting in a higher risk of infection. The aim of this study was to determine the impact of remifentanil discontinuation on intensive care unit (ICU)-acquired infection.

Methods:

This was a prospective observational cohort study performed in a 30-bed medical and surgical university ICU, during a one-year period. All patients hospitalised in the ICU for more than 48 hours were eligible. Sedation was based on a written protocol including remifentanil with or without midazolam. Ramsay score was used to evaluate consciousness. The bedside nurse adjusted sedative infusion to obtain the target Ramsay score. Univariate and multivariate analyses were performed to determine risk factors for ICU-acquired infection.

Results:

Five hundred and eighty-seven consecutive patients were included in the study. A microbiologically confirmed ICU-acquired infection was diagnosed in 233 (39%) patients. Incidence rate of ICU-acquired infection was 38 per 1000 ICU-days. Ventilator-associated pneumonia was the most frequently diagnosed ICU-acquired infection (23% of study patients). Pseudomonas aeruginosa was the most frequently isolated microorganism (30%). Multivariate analysis identified remifentanil discontinuation (odds ratio (OR) = 2.53, 95% confidence interval (CI) = 1.28 to 4.99, P = 0.007), simplified acute physiology score II at ICU admission (1.01 per point, 95% CI = 1 to 1.03, P = 0.011), mechanical ventilation (4.49, 95% CI = 1.52 to 13.2, P = 0.006), tracheostomy (2.25, 95% CI = 1.13 to 4.48, P = 0.021), central venous catheter (2.9, 95% CI = 1.08 to 7.74, P = 0.033) and length of hospital stay (1.05 per day, 95% CI = 1.03 to 1.08, P < 0.001) as independent risk factors for ICU-acquired infection.

Conclusions:

Remifentanil discontinuation is independently associated with ICU-acquired infection.

Insights

Discontinuing remifentanil, an opioid, increases the risk of intensive care unit (ICU)-acquired infections. This finding highlights the importance of managing opioid withdrawal to prevent patient infections in the ICU.

Area of Science:

Critical Care Medicine
Infectious Diseases
Pharmacology

Background:

Opioid withdrawal has been linked to immunosuppression and increased infection risk in animal models.
Understanding the impact of opioid discontinuation on hospital-acquired infections is crucial for patient safety.

Purpose of the Study:

To investigate the association between remifentanil discontinuation and the incidence of intensive care unit (ICU)-acquired infections.
To identify risk factors contributing to ICU-acquired infections.

Main Methods:

A prospective observational cohort study was conducted in a university ICU over one year.
Patients requiring ICU stay >48 hours were assessed for sedation protocols involving remifentanil and Ramsay scores.
Statistical analyses, including multivariate analysis, were used to determine infection risk factors.

Main Results:

Of 587 patients, 39% developed ICU-acquired infections, with ventilator-associated pneumonia being most common.
Remifentanil discontinuation was an independent risk factor (OR=2.53, P=0.007).
Other significant risk factors included SAPS II, mechanical ventilation, tracheostomy, central venous catheter, and length of stay.

Conclusions:

Remifentanil discontinuation is significantly associated with an increased risk of ICU-acquired infections.
Managing opioid withdrawal is critical in preventing infections among critically ill patients.
Findings emphasize the need for careful monitoring during and after remifentanil cessation in the ICU.

Read full analysis

Related Concept Videos

Acute Respiratory Failure-II

Acute Respiratory Failure-II

Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:

Acute Respiratory Failure-III

Acute Respiratory Failure-III

Hypercapnic respiratory failure, also known as Type 2 or ventilatory respiratory failure, is a severe condition characterized by the body's inability to effectively remove carbon dioxide (CO2) from the bloodstream. It leads to an arterial CO2 pressure (PaCO2) exceeding 45 mmHg and a blood pH above 7.35. This situation indicates that the body's ventilatory demand, or the ventilation needed to maintain normal PaCO2 levels, surpasses its supply or the maximum gas flow achievable without causing...

Acute Respiratory Failure-I

Acute Respiratory Failure-I

Acute respiratory failure is a condition characterized by the inability of the lungs to perform their primary function: gas exchange. This failure leads to insufficient oxygen levels (hypoxemia) in the blood, elevated carbon dioxide levels (hypercapnia), or both, causing critical impairment in organ function.
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...

Acute Pyelonephritis II: Diagnostic Studies and Management

Acute Pyelonephritis II: Diagnostic Studies and Management

Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...

Acute Respiratory Failure-V

Acute Respiratory Failure-V

The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...

Acute Respiratory Failure-IV

Acute Respiratory Failure-IV

Respiratory failure can manifest suddenly or gradually, characterized by a rapid decline in PaO2 and a rapid rise in PaCO2. This situation indicates a severe respiratory problem that may quickly become a life-threatening emergency. One of the early signs of hypoxemic Acute Respiratory Failure (ARF) is a change in mental status due to the brain's sensitivity to oxygen levels and changes in acid-base balance. Symptoms such as restlessness, confusion, and agitation suggest inadequate oxygen...

Articles linked to this work by shared authors, journal, and citation graph.

Unclassifiable Invasive Pulmonary Aspergillosis in the Intensive Care Unit: Insights From a Multicenter, Retrospective Cohort Study in France (2022-2024).

Open forum infectious diseases·2026

Impact of a strategy using multiplex PCR on targeted antibiotic therapy for patients with suspected ventilator-associated pneumonia or hospital-acquired pneumonia requiring mechanical ventilation: a randomized, single-blind trial.

Intensive care medicine·2026

When Pneumonia Leads to Sepsis: Clinical Phenotypes and Therapeutic Challenges.

Anaesthesia, critical care & pain medicine·2026

Plasma endocan and cleaved endocan for the diagnosis of microbiologically confirmed ventilator-associated pneumonia in intensive care patients.

Scientific reports·2026

Relationship between negative-pressure ICU rooms and the risk of COVID-19-associated pulmonary aspergillosis: an ancillary analysis of the COVID-ICU cohort study.

Critical care (London, England)·2026

Low versus standard calorie and protein feeding and renal dysfunction in ventilated adults with shock: a NUTRIREA-3 post hoc analysis.

Intensive care medicine·2026

See all related articles