title: Prescribing nonopioids in mechanically ventilated critically ill patients.
abstract: OBJECTIVE
  We searched for factors independently associated with the prescription of multimodal (balanced) analgesia in mechanically ventilated critically ill patients.
  
  
  METHODS
  In this post hoc analysis of a cohort study, 172 patients who received a combination of 1 opioid with nonopioids, that is, paracetamol and/or nefopam, (multimodal analgesia), were compared with 302 patients who received opioid only on day 2 of their stay in the intensive care unit.
  
  
  RESULTS
  Patients given multimodal analgesia were more likely to have fewer organ failures and received fewer hypnotics compared with patients who received opioid only. They self-reported more frequently their pain level. There were no differences in the daily dose of opioids between the 2 groups. A low illness severity score, no more than 1 organ failure on day 2, the ability to self-rate pain, and a moderate-to-severe pain rated on day 2 were factors independently associated with the prescription of multimodal analgesia on day 2 (all P < .01).
  
  
  CONCLUSIONS
  In mechanically ventilated patients, the addition of nonopioids to opioids is mostly prescribed for patients with lower illness severity scores and who are able to self-rate their pain intensity. These findings suggest that the concept of multimodal analgesia must be promoted in the intensive care unit.
authors.affiliation: Pôle d'Anesthésie-Réanimation, Hôpital Michallon, et UJF-Grenoble 1, INSERM U836, Grenoble Institut des Neurosciences, Grenoble, France. jfpayen@ujf-grenoble.fr
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Payen
authors.forename: Celine
authors.initials: C
authors.lastname: Genty
authors.forename: Olivier
authors.initials: O
authors.lastname: Mimoz
authors.forename: Jean
authors.initials: J
authors.lastname: Mantz
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Bosson
authors.forename: Gerald
authors.initials: G
authors.lastname: Chanques
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D016009:Chi-Square Distribution; D016638:Critical Illness; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009340:Nefopam / Q000008:administration & dosage*; D059408:Pain Management; D010147:Pain Measurement; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen; D009340:Nefopam
keywords: Analgesia; Intensive care unit; Opioids; Paracetamol; Sedation