Initial Opioid Exposure in the ICU and 1-Year Opioid-Related Outcomes in Patients Who Are Mechanically Ventilated
Bibliographic record
Abstract
Background Little is known about whether the choice of opioid influences long-term outcomes for critically ill patients. Research Question To determine whether initiation of IV morphine or hydromorphone during mechanical ventilation (MV) is associated with reduced opioid use after discharge relative to fentanyl. Study Design and Methods This was a retrospective cohort study of 14,197 veterans who underwent MV in 116 Veterans Administration hospitals (2014-2020) and who received fentanyl, morphine, or hydromorphone as the initial and only IV opioid during their first 2 days in the ICU. The primary outcome was persistent opioid use in the year after hospital discharge. Results Overall, 11,903 patients (83.8%) received fentanyl, 1,156 patients (8.1%) received morphine, and 1,138 patients (8.0%) received hydromorphone as the initial and only IV opioid during the first 2 days in the ICU. The median patient age was 67 years (interquartile range, 61-72 years). Persistent opioid use in the year after discharge was more common with hydromorphone (16.5%) vs fentanyl (12.0%; adjusted OR [aOR], 1.25; 95% CI, 1.00-1.56), but not with morphine (15.7%) vs fentanyl (aOR, 1.12; 95% CI, 0.91-1.39). Stratified by prior persistent opioid use, the association between opioid initially received in the ICU and an increased risk of persistent use in the following year was present only among individuals without this history for both morphine and hydromorphine compared with fentanyl (morphine: aOR, 1.44 [95% CI, 1.07-1.94]; hydromorphone: aOR, 1.51 [95% CI, 1.12-2.04]). Interpretation Among patients in the ICU who received MV, persistent opioid use in the year after hospital discharge was more frequent among patients initially exposed to IV morphine or hydromorphone compared with fentanyl, but only among those without a prior history of persistent opioid use. The choice of initial opioid may have long-term consequences for patients. Further research is needed to confirm these exploratory findings.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".