Evaluating Routine Opioid Use during Acute Respiratory Failure

摘要/项目总结 在“评估急性呼吸衰竭期间阿片类药物的常规使用”中，我们建议研究 急性呼吸衰竭患者常规使用阿片类药物的实践和长期后果 需要机械通气的病人暴露于处方阿片类药物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品， 疼痛治疗与其他医疗环境中的阿片类药物最小化策略相比，重症监护 指南建议阿片类药物作为与使用机械性 通风机目前，在美国约100万患者中，阿片类药物的处方模式 接受机械呼吸机支持治疗急性呼吸衰竭的国家尚不清楚。此外，本发明还提供了一种方法， 阿片类药物处方的变化，以响应建议阿片类药物作为一线疼痛的重症监护指南 在机械过程中的处理没有被描述。重要的是，阿片类药物之间的联系， 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讨。我们将 使用来自补充来源的现有纵向电子健康记录数据，有效评估阿片类药物 严重疾病后的处方模式和阿片类药物相关结局。我们组建了一个团队 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， 危重病后的研究结果和观察性研究方法。我们的研究将基准临床 急性呼吸衰竭期间阿片类药物使用的实践，并提供对潜在风险和获益的见解 在机械通气期间常规使用阿片类药物的常见但未充分研究的实践。源自我们的 该提案将为未来的治疗建议提供信息，并指导未来随机化的设计和实施。 在重症监护环境中研究阿片类药物限制性镇痛的试验。

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.