Characteristics associated with analgesia ordering in the intensive care unit and relationships with outcome

Amado Freire, Bekele Afessa, Pauline Cawley, Sarah Phelps, Lisa Bridges

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Objective: To describe clinical characteristics associated with analgesia utilization in the intensive care unit. Design: A prospective cohort study of adult patients admitted to a medical intensive care unit. Subjects: Four hundred adult patients. Setting: Twelve-bed medical intensive care unit of an inner-city, university-affiliated hospital. Measurements and Main Results: Collected data included demographics, sedation and neuromuscular blocking agents used, mechanical ventilation, hemodynamic monitoring, Therapeutic Intervention Scoring System score, Logistic Organ Dysfunction System (LODS) score, and Acute Physiology and Chronic Health Evaluation (APACHE) II score. Hospital outcome was noted. The odds ratio and 95% confidence intervals were determined by using multiple logistic regression analyses. Patients' mean age (±SD) was 47.8 ± 17.1 yrs; 58% were male, 84% African-American. Their APACHE II-predicted hospital mortality rate was 33%. Analgesics were used in 36% of patients. There were no differences in demographics, initial LODS score, APACHE II score, and mechanical ventilation use between patients who did and did not receive analgesics. Multiple logistic regression analysis showed that analgesic use was independently associated with sedation (odds ratio, 2.47; 95% confidence interval, 1.47-4.14), neuromuscular blockade (odds ratio, 4.98; 95% confidence interval, 1.85-13.41), and pulmonary artery flotation catheter utilization (odds ratio, 2.31; 95% confidence interval, 1.27-4.20). The median duration of mechanical ventilation was 5 days for those who received analgesia compared with 2 for those who did not (p = .0001). The median length of stay in the intensive care unit (4 vs. 2, p < .0001) and hospital (11 vs. 7, p < .0001) was higher in patients who received analgesics. There were no significant differences in intensive care unit and hospital mortality rates between patients who did and did not receive analgesics. Conclusions: Intensive care unit patients for whom analgesics were prescribed have a higher frequency of hemodynamic monitoring and use of sedative and neuromuscular blocking agents, more mechanical ventilation days, and longer intensive care unit and hospital lengths of stay.

Original languageEnglish (US)
Pages (from-to)2468-2472
Number of pages5
JournalCritical Care Medicine
Volume30
Issue number11
DOIs
StatePublished - Nov 1 2002

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Analgesia
Intensive Care Units
Analgesics
Artificial Respiration
APACHE
Odds Ratio
Confidence Intervals
Organ Dysfunction Scores
Neuromuscular Blocking Agents
Length of Stay
Hospital Mortality
Logistic Models
Hemodynamics
Regression Analysis
Demography
Neuromuscular Blockade
Mortality
Hypnotics and Sedatives
African Americans
Pulmonary Artery

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Characteristics associated with analgesia ordering in the intensive care unit and relationships with outcome. / Freire, Amado; Afessa, Bekele; Cawley, Pauline; Phelps, Sarah; Bridges, Lisa.

In: Critical Care Medicine, Vol. 30, No. 11, 01.11.2002, p. 2468-2472.

Research output: Contribution to journalArticle

Freire, Amado ; Afessa, Bekele ; Cawley, Pauline ; Phelps, Sarah ; Bridges, Lisa. / Characteristics associated with analgesia ordering in the intensive care unit and relationships with outcome. In: Critical Care Medicine. 2002 ; Vol. 30, No. 11. pp. 2468-2472.
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T1 - Characteristics associated with analgesia ordering in the intensive care unit and relationships with outcome

AU - Freire, Amado

AU - Afessa, Bekele

AU - Cawley, Pauline

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AU - Bridges, Lisa

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N2 - Objective: To describe clinical characteristics associated with analgesia utilization in the intensive care unit. Design: A prospective cohort study of adult patients admitted to a medical intensive care unit. Subjects: Four hundred adult patients. Setting: Twelve-bed medical intensive care unit of an inner-city, university-affiliated hospital. Measurements and Main Results: Collected data included demographics, sedation and neuromuscular blocking agents used, mechanical ventilation, hemodynamic monitoring, Therapeutic Intervention Scoring System score, Logistic Organ Dysfunction System (LODS) score, and Acute Physiology and Chronic Health Evaluation (APACHE) II score. Hospital outcome was noted. The odds ratio and 95% confidence intervals were determined by using multiple logistic regression analyses. Patients' mean age (±SD) was 47.8 ± 17.1 yrs; 58% were male, 84% African-American. Their APACHE II-predicted hospital mortality rate was 33%. Analgesics were used in 36% of patients. There were no differences in demographics, initial LODS score, APACHE II score, and mechanical ventilation use between patients who did and did not receive analgesics. Multiple logistic regression analysis showed that analgesic use was independently associated with sedation (odds ratio, 2.47; 95% confidence interval, 1.47-4.14), neuromuscular blockade (odds ratio, 4.98; 95% confidence interval, 1.85-13.41), and pulmonary artery flotation catheter utilization (odds ratio, 2.31; 95% confidence interval, 1.27-4.20). The median duration of mechanical ventilation was 5 days for those who received analgesia compared with 2 for those who did not (p = .0001). The median length of stay in the intensive care unit (4 vs. 2, p < .0001) and hospital (11 vs. 7, p < .0001) was higher in patients who received analgesics. There were no significant differences in intensive care unit and hospital mortality rates between patients who did and did not receive analgesics. Conclusions: Intensive care unit patients for whom analgesics were prescribed have a higher frequency of hemodynamic monitoring and use of sedative and neuromuscular blocking agents, more mechanical ventilation days, and longer intensive care unit and hospital lengths of stay.

AB - Objective: To describe clinical characteristics associated with analgesia utilization in the intensive care unit. Design: A prospective cohort study of adult patients admitted to a medical intensive care unit. Subjects: Four hundred adult patients. Setting: Twelve-bed medical intensive care unit of an inner-city, university-affiliated hospital. Measurements and Main Results: Collected data included demographics, sedation and neuromuscular blocking agents used, mechanical ventilation, hemodynamic monitoring, Therapeutic Intervention Scoring System score, Logistic Organ Dysfunction System (LODS) score, and Acute Physiology and Chronic Health Evaluation (APACHE) II score. Hospital outcome was noted. The odds ratio and 95% confidence intervals were determined by using multiple logistic regression analyses. Patients' mean age (±SD) was 47.8 ± 17.1 yrs; 58% were male, 84% African-American. Their APACHE II-predicted hospital mortality rate was 33%. Analgesics were used in 36% of patients. There were no differences in demographics, initial LODS score, APACHE II score, and mechanical ventilation use between patients who did and did not receive analgesics. Multiple logistic regression analysis showed that analgesic use was independently associated with sedation (odds ratio, 2.47; 95% confidence interval, 1.47-4.14), neuromuscular blockade (odds ratio, 4.98; 95% confidence interval, 1.85-13.41), and pulmonary artery flotation catheter utilization (odds ratio, 2.31; 95% confidence interval, 1.27-4.20). The median duration of mechanical ventilation was 5 days for those who received analgesia compared with 2 for those who did not (p = .0001). The median length of stay in the intensive care unit (4 vs. 2, p < .0001) and hospital (11 vs. 7, p < .0001) was higher in patients who received analgesics. There were no significant differences in intensive care unit and hospital mortality rates between patients who did and did not receive analgesics. Conclusions: Intensive care unit patients for whom analgesics were prescribed have a higher frequency of hemodynamic monitoring and use of sedative and neuromuscular blocking agents, more mechanical ventilation days, and longer intensive care unit and hospital lengths of stay.

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