Opioid overdose leading to intensive care unit admission: Epidemiology and outcomes

Pfister, Gregory; Burkes, Robert; Guinn, Brian E.; Steele, J.E.; Kelley, Robert; Wiemken, Timothy; Saad, Mohamed; Ramirez, Julio A.; Cavallazzi, Rodrigo

doi:10.1016/j.jcrc.2016.04.022

Cited by 29 publications

(32 citation statements)

References 18 publications

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“…Even though the rate of mechanical ventilation reported in our study is significantly higher than in other similar publications [5,13,20,21,24–26], our ICU LOS is comparable to other related series [13,16,26]. As previously outlined in other reports, mechanical ventilation was most frequently required in patients with opiates intoxication [27,28]. …”

Section: Discussionsupporting

confidence: 76%

Clinical and epidemiological characteristics of patients with acute drug intoxication admitted to ICU

Orsini

Din

Elahi

et al. 2017

Journal of Community Hospital Internal Medicine Perspectives

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Background: Drug overdose continues to be the most common cause of acute poisoning worldwide. There has been a substantial increase in drug overdose incidence and prevalence over the past decade, probably as a result of the emergence of new synthetic designer drugs. The purpose of this study is to describe the clinical and epidemiological characteristics of patients with acute drug intoxication admitted to the Intensive Care Unit (ICU). Methods: A single center, prospective, observational study was conducted among all adult patients with clinical signs suggestive of acute drug intoxication admitted from the Emergency Department (ED) to ICU during a 6-month period (September to March). Results: Sixty-five patients were admitted. Their median age was 49 years (mean 48.2, range 20–72), and the majority were male (48, 74%). Median Sequential Organ Failure Assessment (SOFA) score on admission to ICU was 6 (mean 6, range 0–13). Fifty-five patients (85%) had a positive urine and/or serum toxicology screen. Most commonly detected substances were: opiates (18, 33%), cocaine (13, 24%), methadone (12, 22%), benzodiazepines (10, 18%), and marijuana (9, 16%). In 16 patients (29%), >1 substance was isolated. Twenty-three patients (35%) had negative urine toxicology screen. Ethyl alcohol was detected in the serum of 23 patients (35%). Five patients (8%) expired in ICU. Conclusion: Classic recreational drugs remain the most common substances involved in acute drug poisoning. More sensitive detection methods are warranted to identify new designer drugs of abuse such as synthetic cannabinoids.

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Section: Discussionsupporting

confidence: 76%

Clinical and epidemiological characteristics of patients with acute drug intoxication admitted to ICU

Orsini

Din

Elahi

et al. 2017

Journal of Community Hospital Internal Medicine Perspectives

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“…The use of mechanical ventilation is said to be higher among opioid overdose patients as compared to other forms of drug overdose [17]. Two smaller sample size ICU studies with 178 and 42 opioid overdose patients reported that 85% and 88% of admissions in the ICU required IMV, respectively [3,18]. On the other hand, our large study reported that 162,345 out of about 2,528,751 opioid overdose patients on hospitalization required IMV intervention.…”

Section: Discussionmentioning

confidence: 84%

“…This has driven the overall cost of caring for these patients who need critical intensive care from about an average of $58,000 in 2009 to $92,400 in 2015 [7]. Respiratory failure requiring invasive mechanical ventilation is the most common reason for admissions of opioid-associated overdose [3]. This requirement has led to major causes of morbidity and mortality in hospitalized patients presenting with opioid overdose [1].…”

Section: Introductionmentioning

confidence: 99%

Predictors and Outcomes of Invasive Mechanical Ventilation in Opioid Overdose Hospitalization in the United States

Oladunjoye

Olubiyi

et al. 2020

Cureus

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Introduction Opioid overdose is increasingly becoming common and so is the need for invasive mechanical ventilation (IMV) for opioid overdose admissions in hospitalized patients. Respiratory failure requiring invasive mechanical ventilation is the most common reason for the admission of opioid-associated overdose patients. The aim of our study was to assess the demographic and clinical characteristics associated with the increased need for IMV in hospitalized opioid overdose patients. Methods We analyzed all adult admissions (18 years and above) using the National Inpatient Sample (NIS) database for five years from January 1, 2010-December 31, 2014 to identify opioid overdose patients requiring invasive mechanical ventilation. We compared the demographic and clinical characteristics of opioid overdose patients requiring and not requiring mechanical ventilator support and performed univariate and multivariate analyses to determine the odds ratio (OR) of association. Results A total of 2,528,751 opioid overdose patients were identified among which 6.4% required IMV during hospitalization. The prevalence of opioid overdose and the need for IMV increased by 31% and 38%, respectively, over the study period. Multivariate logistic regression (OR (95% CI), p<0.001) determined the following to be associated with increased odds of mechanical ventilator use: (OR 1.12 (1.06-1.19)) among patients aged 25-39 years vs (1.36 (1.28-1.44)) for the age group 40-64 years when compared to 18-24 years; hospital locations in the south US region (OR 1.62 (1.49-1.75)) when compared to the northeast US region; the presence of aspiration pneumonia (OR 14.30 (13.63-15.0)), rhabdomyolysis (3.22 (3.04-3.42)), septic shock (9.15 (8.41-9.97)), and anoxic brain injury (15.5 (13.70-17.50)). Other factors associated with decreased odds of IMV include hepatitis C virus infection (OR 0.75 (0.72-0.79)) and black race (OR 0.68 (0.63-0.74)]. Opioid overdose patients requiring IMV had a higher length of stay by 8.

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“…The recent trend of OUD, the so-called third wave, arose in 2013 as a result of the surge in prescription or illicitly-manufactured synthetic opioids, specifically tramadol, and fentanyl made available to people presenting with pain in the hospital [1]. This has led to a quadrupling of opioid-related deaths since the 2000s [4].…”

Section: Introductionmentioning

confidence: 99%

Trends of Opioid Use Disorder and Associated Factors in Hospitalized Patients With Arthritis

Oladunjoye

Gauvin

et al. 2020

Cureus

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Introduction Opioid use was primarily limited to acute pain, postsurgical care, and end of life care setting but now is the most prescribed medication for chronic pain. Arthritis is a chronic disease associated with chronic pain. Given limited options for pain relief in the patient population, these patients are often prescribed opioids and are at increased risk of opioid use disorder (OUD). Therefore, our study aimed to identify factors associated with OUD in patients with arthritis. Methods We analyzed hospitalized adult patients with arthritis with and without OUD using discharge data from National Inpatient Sample (NIS) over five years from January 1, 2010, to December 31, 2014. We looked at trends of OUD in hospitalized patients with arthritis and compared demographic and clinical characteristics of patients with and without OUD using Student's ttest and chi-square test. Multivariate analysis was also used to adjust for variables. Results A total of 21,396,252 arthritis hospitalizations were identified during the five-year study period among which 227,608 had OUD. The prevalence of OUD in arthritis hospitalization increased over the five-year period by 43%. After adjusting for other variables, mental health (OR 2.50 (2.43-2.58)), and substance use (OR 6.39 (6.14-6.66)) disorders were associated with increased odds of OUD. Conclusion The prevalence of OUD among patients with arthritis increased over the five-year study period. Mental health and substance use disorders were associated with increased odds of OUD. More studies are needed to explore alternative pain management options for arthritis patients particularly in those with mental health and substance use disorders.

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Opioid overdose leading to intensive care unit admission: Epidemiology and outcomes

Cited by 29 publications

References 18 publications

Clinical and epidemiological characteristics of patients with acute drug intoxication admitted to ICU

Clinical and epidemiological characteristics of patients with acute drug intoxication admitted to ICU

Predictors and Outcomes of Invasive Mechanical Ventilation in Opioid Overdose Hospitalization in the United States

Trends of Opioid Use Disorder and Associated Factors in Hospitalized Patients With Arthritis

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