Respiratory medicine · 2026
Dose-dependent association between opioid administration and ventilator-associated pneumonia in sepsis patients receiving mechanical ventilation.
СтатьяНазвание и аннотация: Перевод в очереди
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Lin Shengwei, Chi Lidan, Lu Wenbin, Jin Peipei, Wang Jiafeng, Bian Jinjun
Аннотация
BACKGROUND: This study aimed to investigate the association between opioid administration and the risk of ventilator-associated pneumonia (VAP) in mechanically ventilated (MV) patients in the intensive care unit (ICU).
METHODS: Using a retrospective cohort design, we extracted data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. VAP diagnoses were identified using International Classification of Diseases (ICD) codes. Logistic regression and propensity score matching analyses were performed to evaluate the association between opioid exposure and VAP risk. Subgroup analyses evaluated the influence of comorbidities, including diabetes, congestive heart failure, and chronic pulmonary disease.
RESULTS: Among 6978 patients, 668 (9.6%) developed VAP. Patients in the high-opioid group (fentanyl equivalent daily dose >2.47 mg/day) exhibited a significantly increased risk of VAP (OR: 2.12, 95% CI: 1.77-2.54, P < 0.001). After propensity score matching, the high-opioid group maintained a higher VAP risk compared to the low-opioid group (OR: 1.86, 95% CI: 1.52-2.27, P < 0.001). Secondary outcomes revealed that the high-opioid group had elevated risks of acute kidney injury (AKI) within 7 days of ICU admission (OR: 1.54, 95% CI: 1.35-1.76, P < 0.001). Additionally, 30-day mortality was higher in the high-opioid group (HR: 2.65, 95% CI: 2.24-3.13, P < 0.001).
CONCLUSIONS: Our findings demonstrate a significant association between opioid administration and an increased risk of VAP, particularly in sepsis patients with specific comorbidities. These results highlight the need for careful opioid dosing strategies in critically ill, mechanically ventilated patients.
METHODS: Using a retrospective cohort design, we extracted data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. VAP diagnoses were identified using International Classification of Diseases (ICD) codes. Logistic regression and propensity score matching analyses were performed to evaluate the association between opioid exposure and VAP risk. Subgroup analyses evaluated the influence of comorbidities, including diabetes, congestive heart failure, and chronic pulmonary disease.
RESULTS: Among 6978 patients, 668 (9.6%) developed VAP. Patients in the high-opioid group (fentanyl equivalent daily dose >2.47 mg/day) exhibited a significantly increased risk of VAP (OR: 2.12, 95% CI: 1.77-2.54, P < 0.001). After propensity score matching, the high-opioid group maintained a higher VAP risk compared to the low-opioid group (OR: 1.86, 95% CI: 1.52-2.27, P < 0.001). Secondary outcomes revealed that the high-opioid group had elevated risks of acute kidney injury (AKI) within 7 days of ICU admission (OR: 1.54, 95% CI: 1.35-1.76, P < 0.001). Additionally, 30-day mortality was higher in the high-opioid group (HR: 2.65, 95% CI: 2.24-3.13, P < 0.001).
CONCLUSIONS: Our findings demonstrate a significant association between opioid administration and an increased risk of VAP, particularly in sepsis patients with specific comorbidities. These results highlight the need for careful opioid dosing strategies in critically ill, mechanically ventilated patients.