Evaluating Routine Opioid Use during Acute Respiratory Failure

摘要/项目摘要 在《急性呼吸衰竭时常规阿片类药物使用的评估》中，我们建议研究处方 在急性呼吸衰竭患者中常规使用阿片类药物的做法和长期影响 在美国需要机械通风的人。接触处方类阿片可能会产生阿片类药物- 相关并发症，导致医疗保健组织越来越多地推荐非阿片类药物替代 疼痛治疗。与其他医疗保健环境中的阿片类药物最小化策略不同，重症监护 指南建议将阿片类药物作为与使用机械装置相关的不适的一线治疗 通风器。目前，在美国大约100万名患者中，阿片类药物的处方模式 目前尚不清楚哪些州接受了机械呼吸机对急性呼吸衰竭的支持。此外, 根据建议将阿片类药物作为一线疼痛的重症监护指南，阿片类药物处方的变化 在机械治疗过程中没有描述。重要的是，阿片类药物之间的联系在 机械通气和长期使用阿片类药物以及与阿片类药物相关的并发症仍未得到探索。我们会 使用来自互补来源的现有纵向电子健康记录数据来有效评估阿片类药物 危重疾病后的处方模式和阿片类药物相关结果。我们已经组建了一个团队，有一支 阿片类药物使用流行病学方面的合作记录和专门知识，使用电子健康记录数据 危重疾病后的研究结果，以及观察性研究方法。我们的研究将作为临床基准 急性呼吸衰竭期间使用阿片类药物的实践，并提供对潜在风险和好处的见解 在机械通气期间常规使用阿片类药物的一种常见但未被充分研究的做法。结果来自我们的 提案将告知未来的治疗建议，并指导未来随机试验的设计和实施 在重症监护环境中研究阿片类药物受限止痛的试验。

ABSTRACT / PROJECT SUMMARY In “Evaluating Routine Opioid Use during Acute Respiratory Failure”, we propose to study the prescribing practices and long-term ramifications of the routine use of opioids among patients with acute respiratory failure who require mechanical ventilation in the United States. Exposure to prescription opioids may produce opioid- related complications, leading healthcare organizations to increasingly recommend non-opioid alternatives to pain treatment. In contrast to opioid minimization strategies within other healthcare settings, critical care guidelines recommend opioids as the first-line treatment for discomfort that associated with use of a mechanical ventilator. Currently, prescribing patterns for opioids among the approximately 1 million patients in the United States who receive support from a mechanical ventilator for acute respiratory failure are unclear. In addition, changes in opioid prescribing in response to critical care guidelines that recommend opioids as first line pain treatment during mechanical have not been described. Importantly, links between opioids prescribed during mechanical ventilation and long-term opioid use and opioid-related complications remain unexplored. We will use existing longitudinal electronic health record data from complementary sources to efficiently evaluate opioid prescribing patterns and opioid-associated outcomes after critical illness. We have assembled a team with a record of collaboration and expertise in the epidemiology of opioid use, use of electronic health record data to study outcomes after critical illness, and observational research methodology. Our study will benchmark clinical practice for opioid use during acute respiratory failure, and provide insights into the potential risks and benefits of a common, but understudied practice of routine opioid use during mechanical ventilation. Results from our proposal will inform future therapeutic recommendations, and guide the design and conduct of future randomized trials investigating opioid-limited analgesia in the intensive care setting.