Introduction

Opioids are potent painkillers but can have severe adverse effects in the intensive care unit (ICU). The aim of this study was to compare the outcomes of fentanyl and morphine use among patients at risk for and with acute respiratory distress syndrome (ARDS).

Methods

We developed a dataset of real-world data to enable the comparison of the effectiveness and safety of opioids and the associated outcomes from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC)-III database and the eICU Collaborative Research Database. Patients who were admitted to the ICU with a diagnosis of or at risk for ARDS and received mechanical ventilation for at least 12 h were included. Patients were enrolled sequentially into one of six groups in three cohorts: treated with fentanyl or not; treated with morphine or not; and treated with fentanyl or morphine. Propensity score matching and multivariable analyses were performed.

Results

Fentanyl was associated with higher in-hospital mortality in the propensity score-matched model but not in the linear regression model. The use of morphine was associated with a higher in-hospital mortality in both models. Both fentanyl and morphine were associated with longer duration of mechanical ventilation, ICU stay, and hospitalization and a decreased likelihood of being discharged home in both models. Notably, compared with morphine, fentanyl was associated with a lower mortality and an increased likelihood of being discharged home.

Conclusions

Both fentanyl and morphine were independent risk factors for worse outcomes in patients with or at risk for ARDS. Compared with morphine, fentanyl may be preferred in these patients.

中文翻译：

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芬太尼和吗啡对急性呼吸窘迫综合征患者或有患急性呼吸窘迫综合征风险的患者的疗效比较：倾向评分匹配队列研究

介绍

阿片类药物是有效的止痛药，但在重症监护病房 (ICU) 中可能会产生严重的副作用。本研究的目的是比较有急性呼吸窘迫综合征 (ARDS) 风险和患有急性呼吸窘迫综合征 (ARDS) 的患者使用芬太尼和吗啡的结果。

方法

我们开发了一个真实世界数据的数据集，以比较来自重症监护多参数智能监测 (MIMIC)-III 数据库和 eICU 协作研究数据库的阿片类药物的有效性和安全性以及相关结果。纳入 ICU 诊断为 ARDS 或有 ARDS 风险并接受机械通气至少 12 小时的患者。患者被依次纳入三个队列的六组之一：是否接受芬太尼治疗；是否接受吗啡治疗；并用芬太尼或吗啡治疗。进行了倾向评分匹配和多变量分析。

结果

在倾向评分匹配模型中，芬太尼与较高的院内死亡率相关，但在线性回归模型中则不然。在两种模型中，使用吗啡都与较高的院内死亡率相关。在两种模型中，芬太尼和吗啡都与机械通气持续时间、ICU 住院时间和住院时间延长以及出院回家的可能性降低有关。值得注意的是，与吗啡相比，芬太尼与较低的死亡率和出院回家的可能性增加有关。

结论

芬太尼和吗啡都是 ARDS 患者或有患 ARDS 风险的患者预后较差的独立危险因素。与吗啡相比，芬太尼可能是这些患者的首选。