잠시만 기다려 주세요. 로딩중입니다.

Iatrogenic Opioid Withdrawal Syndrome in Critically Ill Patients: a Retrospective Cohort Study

Journal of Korean Medical Science 2020년 35권 15호 p.106 ~ 106
현동곤, 허진원, 홍상범, 고윤석, 임채만,
소속 상세정보
현동곤 ( Hyun Dong-Gon ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
허진원 ( Huh Jin-Won ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
홍상범 ( Hong Sang-Bum ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
고윤석 ( Koh Youn-Suck ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
임채만 ( Lim Chae-Man ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine

Abstract


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.

키워드

Analgesics; Ventilators; Intensive Care Unit; Substance Withdrawal Syndrome; Incidence

원문 및 링크아웃 정보

  

등재저널 정보