Prescribing nonopioids in mechanically ventilated critically ill patients

Jean Francois Payen, Celine Genty, Olivier Mimoz, Jean Mantz, Jean Luc Bosson, Gerald Chanques

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: We searched for factors independently associated with the prescription of multimodal (balanced) analgesia in mechanically ventilated critically ill patients. Methods: In this post hoc analysis of a cohort study, 172 patients who received a combination of 1 opioid with nonopioids, that is, paracetamol and/or nefopam, (multimodal analgesia), were compared with 302 patients who received opioid only on day 2 of their stay in the intensive care unit. Results: Patients given multimodal analgesia were more likely to have fewer organ failures and received fewer hypnotics compared with patients who received opioid only. They self-reported more frequently their pain level. There were no differences in the daily dose of opioids between the 2 groups. A low illness severity score, no more than 1 organ failure on day 2, the ability to self-rate pain, and a moderate-to-severe pain rated on day 2 were factors independently associated with the prescription of multimodal analgesia on day 2 (all P < .01). Conclusions: In mechanically ventilated patients, the addition of nonopioids to opioids is mostly prescribed for patients with lower illness severity scores and who are able to self-rate their pain intensity. These findings suggest that the concept of multimodal analgesia must be promoted in the intensive care unit.

Original languageEnglish (US)
Pages (from-to)534.e7-534.e12
JournalJournal of Critical Care
Volume28
Issue number4
DOIs
StatePublished - Aug 2013

Keywords

  • Analgesia
  • Intensive care unit
  • Opioids
  • Paracetamol
  • Sedation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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