BackgroundWhile opioid use confers a known risk for respiratory depression, the incremental risk of in-hospital cardiopulmonary arrest, respiratory arrest, or cardiopulmonary resuscitation (CPRA) has not been studied. Our aim was to investigate the prevalence, outcomes, and risk profile of in-hospital CPRA for patients receiving opioids and medications with central nervous system sedating side effects (sedatives).MethodsA retrospective analysis of adult inpatient discharges from 2008–2012 reported in the Premier Database. Patients were grouped into four mutually exclusive categories: (1) opioids and sedatives, (2) opioids only, (3) sedatives only, and (4) neither opioids nor sedatives.ResultsAmong 21,276,691 inpatient discharges, 53% received opioids with or without sedatives. A total of 96,554 patients suffered CPRA (0.92 per 1000 hospital bed-days). Patients who received opioids and sedatives had an adjusted odds ratio for CPRA of 3.47 (95% CI: 3.40–3.54; p<0.0001) compared with patients not receiving opioids or sedatives. Opioids alone and sedatives alone were associated with a 1.81-fold and a 1.82-fold (p<0.0001 for both) increase in the odds of CPRA, respectively. In opioid patients, locations of CPRA were intensive care (54%), general care floor (25%), and stepdown units (15%). Only 42% of patients survived CPRA and only 22% were discharged home. Opioid patients with CPRA had mean increased hospital lengths of stay of 7.57 days and mean increased total hospital costs of $27,569.ConclusionsOpioids and sedatives are independent and additive risk factors for in-hospital CPRA. The impact of opioid sparing analgesia, reduced sedative use, and better monitoring on CPRA incidence deserves further study.
There is a high prevalence of AAAs (5.8%) and clinically relevant AAAs (4.1%) detected on routine abdominal CT. As an opportunistic approach, it is a simple and effective way to detect AAAs and to broaden traditional screening criteria to include women and those younger than 65 years in our region. Furthermore, large numbers of subjects with normal aortic diameters are identified who will not need to be screened. Consequently, we consider routine diagnostic abdominal CT to be an important adjunct to national and community AAA screening strategies.
Computerized tomography ( 0 now has a definite place in the assessment of aortic vascular disease. In a study of 96 patients with abdominal or thoracic aorto-iliac problems, CT proved most useful in the management of haemodynamically stable patients with abdominal aortic aneurysms that were suspected of leaking. The complex anatomy associated with thoracic and abdominal aneurysms and aortic dissection was clearly defined. The interpretation of scans on postoperative aortic graft patients was difficult and less often helpful. The incidental finding of aortic disease during abdominal scans for a variety of other indications was infrequent and seldom contributed to patient management. The indications for CT have become far more selective.
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