Admissions to intensive care units (ICUs) for opioid overdose in the United States have increased significantly over time, straining critical care resources, a new study shows.
“Not only did the number of opioid-related overdose patients requiring ICU care increase above and beyond the increasing supply of critical care admissions, the mortality among this population increased as well, leading us to estimate that there was a near doubling of ICU deaths from opioid overdoses in September 2015 compared with January 2009,” the investigators report.
“These patients also required more intense care, as reflected by the use of more renal replacement therapy at significantly higher costs,” they add.
The study was published online August 11 in the Annals of the American Thoracic Society.
Heroin a Major Contributor
Lena Novack, PhD, of Ben-Gurion University of the Negev, in Israel, and colleagues from Harvard Medical School, in Boston, Massachusetts, and the University of Chicago, in Illinois, analyzed nearly 23 million hospital admissions and 4.1 million ICU admissions at 162 hospitals in 44 states from January 1, 2009, through September 30, 2015.
A total of 21,705 opioid overdose admissions required ICU care. Cases included overdose of prescription opioids, methadone, and heroin. There were 52.4 ICU admissions for opioid overdose per 10,000 ICU admissions during the entire study period.
During the study period, opioid overdose admissions needing intensive care jumped 34%, from 44 per 10,000 to 50 per 10,000 ICU admissions. The death rate of patients with ICU admissions for opioid overdoses also increased. It had averaged 7% but increased to close to 10% by 2015.
“Although our data are not definitive, they suggest that overdoses from heroin, rather than prescription opioids, appear to be a major contributor to the rise in critical care mortality for this population,” the researchers note.
They point out that Massachusetts and Indiana had the highest opioid admission densities in the nation. Pennsylvania experienced the sharpest rise in opioid-related overdoses during the study period, with critical care overdose admissions nearly doubling since 2009. Illinois, California, New York, and Indiana also experienced increases in ICU admission rates during the period.
During the study period, the average cost of care per ICU overdose admission increased 58%, from $58,517 in 2009 to $92,408 in 2015.
Underestimate?
On average, about 10% of ICU patients with overdose required mechanical ventilation. This percentage did not change appreciably over time. Seven percent of this population required noninvasive ventilation, and 4% needed vasopressors. Critically ill overdose patients required renal replacement therapy 37% more often in 2015 than in 2009 (4.5% in 2009 to 6.1% in 2015 of ICU admissions for overdose).
This study provides the first description of the impact of the current opioid addiction crisis to the critical care community, the researchers say. The findings suggest a “growing demand for critical care support” for opioid abusers, particularly in regions of the country where the need for critical care for patients with overdoses is already high, they note.
The investigators emphasized that the admissions were identified using the Clinical Data Base/Resource Manager of Vizient, Inc, which is made up of data mainly from urban academic medical centers and may not reflect overdose-related acute care needs in other settings.
“Our estimates may actually be on the low side,” Dr Novack said in a news release. “Since our team of researchers analyzed admissions rather than a manual chart review, we may not have captured every admission if opioid-related complications weren’t coded as such.”
The study also could not determine whether increased ICU admissions for opioid overdoses resulted from improved community emergency response that may have saved the lives of patients who then required critical care, or whether the increased ICU admissions indicate that improvements are needed with regard to community emergency response so that patients require less intensive hospital care.
“Our findings raise the need for a national approach to developing safe strategies to care for ICU overdose patients, to providing coordinated resources in the hospital for patients and families, and to helping survivors maintain sobriety following discharge,” they conclude.
The study had no funding. The authors have disclosed no relevant financial relationships.
Ann Am Thorac Soc. Published online August 11, 2017. Abstract
Tidak ada komentar:
Posting Komentar