在急性呼吸衰竭患者接受侵入性机械通风的阿片类药物管理实践模式
Laura C Myers1,2, Nicholas A Bosch3,4, Lauren Soltesz1,2
1Division of Research, Kaiser Permanente Northern California, Oakland, CA.
Critical care explorations
|July 17, 2024
概括
在急性呼吸衰竭的机械通风患者中,阿片类药物输液是常见的,但使用和剂量在各医院之间有很大差异. 这种变化表明潜在的治疗不足和过度治疗,影响患者的护理.
科学领域:
- 关键护理医学 关键护理医学
- 药理学 药理学是指药理学的学科.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 阿片类药物危机需要仔细检查医疗保健环境中的阿片类药物使用情况.
- 对于急性呼吸衰竭的机械通风通常涉及阿片类药物管理.
- 了解阿片类药物管理的实践变化对于患者安全至关重要.
研究的目的:
- 评估在接受侵入性机械通风的急性呼吸衰竭患者的阿片类药物输注和剂量的实践模式.
- 量化阿片类药物使用和芬太尼等效剂量的医院间变化.
主要方法:
- 这是一项回顾性队列研究,包括13,140名患者 (Kaiser Permanente北加州) 和52,033名患者 (菲利普斯电子ICU研究所).
- 在机械通风的前21天内,评估了阿片类药物输注和每日 fentanyl 相当剂量的中位数.
- 利用等级回归模型来确定阿片类药物使用和剂量的医院级变化.
主要成果:
- 在急性呼吸衰竭的机械通风患者中,超过53% (KPNC) 和31% (eRI) 接受了阿片类药物输液.
- 入院医院解释了阿片类药物输注使用的变化7% (KPNC) 和39% (eRI).
- 平均每日芬太尼等效剂量为692微克 (KPNC) 和200微克 (eRI),医院对剂量有所不同 (4%在KPNC,20%在eRI).
结论:
- 机械通风患者的阿片类药物输注实践存在显著差异,表明潜在的治疗不足和过度治疗.
- 这些发现支持对风险调整后的平均值进行医院镇痛实践的比较.
- 结果可以为临床试验的设计提供信息,用于重症监护机构的止痛和镇静.
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