6: ASSOCIATION BETWEEN OPIOID ADMINISTRATION DURING MECHANICAL VENTILATION AND SUBSEQUENT OPIOID USE
Bibliographic record
Abstract
Introduction: An analgesia-first sedation strategy during mechanical ventilation (MV) is a guideline-based intensive care unit (ICU) practice, resulting in many critically ill patients receiving opioids. Healthcare opioid exposure in non-ICU settings is associated with subsequent outpatient opioid use, but the long-term impact of opioid administration during MV is uncharacterized. We hypothesized that higher opioid doses during MV would result in increased opioid use after hospital discharge. Methods: Our retrospective cohort study included adult patients in 21 Kaiser Permanente Northern California medical ICUs (2012-2019) who received MV ≥24 hours for acute respiratory failure, survived to discharge, and did not have prior comfort-focused care/hospice referral. The primary exposure was tercile of median daily fentanyl equivalents (MDFE) administered during the first 21 MV days. Patients who did not receive opioids were the reference group. The primary outcome was a filled opioid prescription (Rx) in the year after discharge modeled using a time to event analysis with death as a competing risk. Secondary outcomes included 1) an opioid Rx filled in 30 days, 2) an opioid Rx filled in 1 year and 3) persistent opioid use over 1 year, all modeled as binary outcomes using logistic regression. Models were adjusted for patient demographics; social determinants of health; Charlson comorbidities; opioid Rx, chronic pain, or opioid-related diagnoses in the prior year; principal diagnosis; length of stay; and code status. Results: We included 6,746 patients; 2,942 (43.6%) experienced the primary outcome. The MDFE distribution was a median 200µcg (Interquartile range 40µcg, 1000µcg) with Tercile 1 0-67µcg, Tercile 2 >67-700µcg and Tercile 3 >700µcg. Compared to patients who received no opioid, higher MDFE was associated with more opioid Rxs in the year after discharge: Tercile 1 Hazard Ratio (HR) 1.01 (95% Confidence Interval 0.87-1.18), Tercile 2 HR 1.23 (1.06-1.43), Tercile 3 HR 1.31 (1.13-1.53). Results were similar for secondary outcomes. Conclusions: Administering higher opioid doses during MV is associated with increased post-discharge opioid use, including persistent use. Given the harms of the ongoing opioid epidemic, future studies should evaluate the risks and benefits of opioid-sparing strategies during MV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".