A national survey of approaches to manage the ICU patient with opioid use disorder

Reichheld, Alyse; Hills-Evans, Kelsey; Sheehan, Julie; Tocci, N.; Tandon, Mudit; Hsu, Douglas J.; Marshall, John; OʼDonoghue, Sharon C; Stevens, Jennifer P.

doi:10.1016/j.jcrc.2019.06.032

Cited by 12 publications

(15 citation statements)

References 35 publications

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“…Por outro lado, estes medicamentos são classificados como potencialmente perigosos por sua alta probabilidade de acarretar eventos adversos e dano ao paciente 7,24,25 . Desta forma, a implantação de protocolos de uso e prevenção de erros de medicação, aliados a prevenção e acompanhamento de reações adversas são de extrema importância para garantir um ambiente seguro para os pacientes criticamente doentes 25,26 .…”

Section: Discussionunclassified

Fatores associados para potenciais interações medicamentosas clinicamente significantes em terapia intensiva adulto

Moraes

Maia

Trindade

et al. 2020

Medicina (Ribeirão Preto)

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Modelo do estudo: Estudo transversal. Objetivo: caracterizar as interações medicamentosas potenciais (IMp) maiores e contraindicadas em terapia intensiva adulto e determinar sua prevalência, medicamentos e fatores associados à exposição dessas interações. Métodos: a amostra foi composta por 309 pacientes internados em uma unidade de terapia intensiva adulto de um hospital da Região Centro-Oeste de Minas Gerais, Brasil. Os dados demográficos-clínicos e perfil medicamentoso foram coletados, prospectivamente. As IMp foram caracterizadas pela base Micromedex 2.0 quanto à gravidade, prevalência e implicação clínica. Realizaram-se análises descritivas para as variáveis qualitativas e contínuas. Modelos Lineares Generalizados com distribuição Gama e Poisson foram utilizados para avaliar a relação entre um conjunto de variáveis independentes e a prevalência de IMp maiores e contraindicadas (p<0.05). Resultados: Um total de 81,8% (n=251) foi exposto a, no mínimo, uma IMp maior ou contraindicada. Mais de um terço (37,4%) destes participantes foram expostos a seis ou mais IMp. Medicamentos com ação no sistema nervoso colaboraram para maior probabilidade de IMp maiores e/ou contraindicadas. Pessoas idosas (p=0,006), do sexo masculino (p=0,028) e polimedicadas (<0,001) tiveram maior probabilidade de serem expostas ao menos a uma IMp maior ou contraindicada. Conclusão: Interações medicamentosas potenciais maiores e contraindicadas apresentaram alta frequência. Pessoas idosas, do sexo masculino e polimedicadas foram mais expostas às IMp maiores e/ou contraindicadas. É importante que profissionais da saúde conheçam os riscos e potenciais eventos adversos relacionados às IMp maiores e contraindicadas, para que sejam implementadas medidas para promoção da segurança do paciente.

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Section: Discussionunclassified

Fatores associados para potenciais interações medicamentosas clinicamente significantes em terapia intensiva adulto

Moraes

Maia

Trindade

et al. 2020

Medicina (Ribeirão Preto)

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“…A 2019 paper identified that few units have guidelines for managing patients with OUD or patients on OAT, although the majority of respondents to this survey, who were predominantly ICU nurses, reported that methadone was continued in ICUs. 53 Therefore our recommendations are empirical. The major considerations are the clinical situation in terms of the need for sedation/analgesia; the clinical situation in terms of the need for rapid control of level of sedation/respiratory drive; the risks of opioid withdrawal, in particular sympathetic overdrive; the risk of inadequate pain management from opioid withdrawal due to inadequate opioid replacement. …”

Section: Icu Managementmentioning

confidence: 99%

“…If naloxone is required, over-reversal should be avoided as this can precipitate withdrawal. 53 Precipitated withdrawal is unpleasant for the patient and carries some risk from sympathetic overactivity.…”

Section: Opioid Antagonistsmentioning

confidence: 99%

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Opioid use disorder in anaesthesia and intensive care: Prevention, diagnosis and management

Murnion

Demirkol

2022

Anaesth Intensive Care

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Opioid misuse is common, as is opioid agonist treatment of opioid dependence. Almost 3% of Australians and over 3.5% of those living in New Zealand report misuse of analgesics. Over 50,000 Australians receive opioid agonist treatment with methadone or buprenorphine for management of severe opioid use disorder. The perioperative period is an opportunity to identify pre-existing opioid misuse, and to introduce interventions to reduce the risk of development of opioid use disorder. Challenges of acute perioperative pain management or intensive care management of patients receiving opioid agonist treatment include opioid tolerance and ongoing prescribing of methadone or buprenorphine. There has been some ambiguity about the optimal perioperative management of buprenorphine, a partial agonist at the mu receptor. In this article, a framework to identify emerging opioid misuse problems, identify risk of overdose and to manage the opioid-dependent patient on opioid agonist treatment perioperatively or in the intensive care unit is provided. Diagnostic criteria and risk stratification criteria are presented. Management strategies include trauma-informed care, care planning and care coordination with community practitioners and opioid agonist treatment providers. Continuing methadone or buprenorphine perioperatively with additional opioid and non-opioid analgesia is generally recommended. Increased opioid agonist treatment doses may be required on discharge. An algorithm for decisions about opioid agonist treatment management in the intensive care unit based on the risks of opioid withdrawal and toxicity is considered. Strategies for managing the opioid-dependent patient who is not in treatment are also discussed.

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“…In a recent survey of 54 ICUs across the United States assessing management of critically ill patients with OUD, only 7% of institutions reported a protocol that addressed sedation and analgesia needs in patients with OUD. One institution reported a protocol for the management of MOUD, and only 36% of institutions offered patients outpatient resources upon discharge 11 . Due to a significant gap in the literature addressing these concerns, this review serves to provide (1) guidance and treatment recommendations for the management of acute pain in opioid tolerant patients on MOUD and patients actively misusing opioids admitted to ICU settings and (2) recommendations on initiating inpatient OUD treatment.…”

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confidence: 99%

Pain Management Considerations in Patients With Opioid Use Disorder Requiring Critical Care

Smith

Wang

Abdukalikov

et al. 2022

The Journal of Clinical Pharma

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The opioid epidemic has resulted in increased opioid‐related critical care admissions, presenting challenges in acute pain management. Limited guidance exists in the management of critically ill patients with opioid use disorder (OUD). This narrative review provides the intensive care unit clinician with guidance and treatment options, including nonopioid analgesia, for patients receiving medications for OUD and for patients actively misusing opioids. Verification and continuation of the patient's outpatient medications for OUD regimen, specifically buprenorphine and methadone formulations; assessment of pain and opioid withdrawal; and treatment of acute pain with nonopioid analgesia, nonpharmacologic strategies, and short‐acting opioids as needed, are all essential to adequate management of acute pain in patients with OUD. A multidisciplinary approach to treatment and discharge planning in patients with OUD may be beneficial to engage patients with OUD early in their hospital stay to prevent withdrawal, stabilize their OUD, and reduce the risk of unplanned discharge and other associated morbidity.

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A national survey of approaches to manage the ICU patient with opioid use disorder

Cited by 12 publications

References 35 publications

Fatores associados para potenciais interações medicamentosas clinicamente significantes em terapia intensiva adulto

Fatores associados para potenciais interações medicamentosas clinicamente significantes em terapia intensiva adulto

Opioid use disorder in anaesthesia and intensive care: Prevention, diagnosis and management

Pain Management Considerations in Patients With Opioid Use Disorder Requiring Critical Care

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