Iatrogenic Opioid Withdrawal Syndrome in Critically Ill Patients: a Retrospective Cohort Study
Iatrogenic Opioid Withdrawal Syndrome in Critically Ill Patients: a Retrospective Cohort Study
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DOI：
10.3346/jkms.2020.35.e106
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发表时间：
2020-04-20
影响因子：
4.5
通讯作者：
Lim, Chae-Man
中科院分区：
文献类型：
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作者：
Hyun, Dong-gon;Huh, Jin Won;Lim, Chae-Man
背景：阿片类镇痛剂的减少或停药可导致阿片类药物戒断综合征。在危重儿科患者中，OWS是一种常见且临床意义重大的疾病。然而，成人患者的OWS尚未得到详细评估。因此，我们的目的是调查在成人重症监护病房(ICU)接受机械通气的患者中OWS的发生率、危险因素和临床特征。方法：这项研究是对在内科ICU接受治疗3天且只接受一种阿片类止痛药的患者的数据进行回顾评估。从停止或减少(50%)持续阿片类药物输注开始，对OWS进行24小时的评估。结果：在接受瑞芬太尼(n=58)、芬太尼(n=47)和吗啡(n=21)治疗的患者中，观察组的发生率分别为31.0%、36.2%和9.5%(P=0.078)。最常见的症状是呼吸频率改变(瑞芬太尼94.4%；芬太尼76.5%；吗啡100%)。多因素COX比例风险模型显示，OWS与吗啡治疗(危险比[HR]，0.17；95%可信区间[CI]，0.037~0.743)和阿片类药物输注时间(HR，0.566；95%CI，0.451~0.712)呈负相关。结论：OWS在持续输注阿片类药物3天的机械通气成人患者中并不少见。使用吗啡可能与OWS风险降低有关。
Background: Opioid withdrawal syndrome (OWS) may occur following the reduction or discontinuation of opioid analgesics. In critically ill pediatric patients, OWS is a common and clinically significant condition. However, OWS in adult patients has not been assessed in detail. Therefore, we aimed to investigate the incidence, risk factors, and clinical features of OWS in mechanically ventilated patients treated in an adult intensive care unit (ICU).Methods: This study was a retrospective evaluation of data from patients treated in the medical ICU for > 3 days and who received only one type of opioid analgesic. OWS was assessed over a 24 hours period from discontinuation or reduction (by > 50%) of continuous opioid infusion. OWS was defined as the presence of >= 3 central nervous system or autonomic nervous system symptoms.Results: In 126 patients treated with remifentanil (n = 58), fentanyl (n = 47), or morphine (n = 21), OWS was seen in 31.0%, 36.2%, and 9.5% of patients, respectively ( P = 0.078). The most common symptom was a change in respiratory rate (remifentanil, 94.4%; fentanyl, 76.5%; morphine, 100%). Multivariate Cox-proportional hazards model showed that OWS was negatively associated with morphine treatment (hazard ratio [HR], 0.17; 95% confidence interval [CI], 0.037-0.743) and duration of opioid infusion (HR, 0.566; 95% CI, 0.451-0.712).Conclusion: OWS is not uncommon in mechanically ventilated adult patients who received continuous infusion of opioids for > 3 days. The use of morphine may be associated with a decreased risk of OWS.