title: En Route Use of Analgesics in Nonintubated, Critically Ill Patients Transported by U.S. Air Force Critical Care Air Transport Teams.
abstract: U.S. Critical Care Air Transport Teams (CCATTs) evacuate critically ill patients with acute pain in the combat setting. Limited data have been reported on analgesic administration en route, and no study has reported analgesic use by CCATTs. Our objective was to describe analgesics used by CCATTs for nonintubated, critically ill patients during evacuation from a combat setting.
  
  
  
  We conducted an institutional review board-approved, retrospective review of CCATT records. We included nonintubated, critically ill patients who were administered analgesics in flight and were evacuated out of theater (2007-2012). Demographics, injury description, analgesics and anesthetics, and predefined clinical adverse events were recorded. Data were presented as mean ± standard deviation or percentage (%).
  
  
  
  Of 1,128 records, we analyzed 381 subjects with the following characteristics: age 26 ± 7.0 years; 98% male; and 97% trauma (70% blast, 17% penetrating, 11% blunt, and 3% burn). The injury severity score was 19 ± 9. Fifty-one percent received morphine, 39% hydromorphone, 15% fentanyl, and 5% ketamine. Routes of delivery were 63% patient-controlled analgesia (PCA), 32% bolus intravenous (IV) administration, 24% epidural delivery, 21% continuous IV infusions, and 9% oral opioids. Patients that were administered local anesthetics (nerve block or epidural delivery) with IV opioids received a lower total dose of opioids than those who received opioids alone. No differences were associated between analgesics and frequency of complications in flight or postflight.
  
  
  
  About half of nonintubated, critically ill subjects evacuated out of combat by CCATT received morphine and more than half had a PCA. In our study, ketamine was not frequently used and pain scores were rarely recorded. However, we detected an opioid-sparing effect associated with local anesthetics (regional nerve blocks and epidural delivery).
authors.affiliation: Air Force En route Care Research Center, U.S. Army Institute of Surgical Research/59th MDW, 3698 Chambers Pass Road, Building 3611, Fort Sam Houston, TX 78234.
authors.forename: Alejandra G
authors.initials: AG
authors.lastname: Mora
authors.affiliation: Air Force En route Care Research Center, U.S. Army Institute of Surgical Research/59th MDW, 3698 Chambers Pass Road, Building 3611, Fort Sam Houston, TX 78234.
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Ganem
authors.affiliation: Air Force En route Care Research Center, U.S. Army Institute of Surgical Research/59th MDW, 3698 Chambers Pass Road, Building 3611, Fort Sam Houston, TX 78234.
authors.forename: Alicia T
authors.initials: AT
authors.lastname: Ervin
authors.affiliation: Air Force En route Care Research Center, U.S. Army Institute of Surgical Research/59th MDW, 3698 Chambers Pass Road, Building 3611, Fort Sam Houston, TX 78234.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Maddry
authors.affiliation: Air Force En route Care Research Center, U.S. Army Institute of Surgical Research/59th MDW, 3698 Chambers Pass Road, Building 3611, Fort Sam Houston, TX 78234.
authors.forename: Vikhyat S
authors.initials: VS
authors.lastname: Bebarta
mesh_terms: D000328:Adult; D000337:Aerospace Medicine; D055826:Afghan Campaign 2001-; D017732:Air Ambulances / Q000706:statistics & numerical data; D000700:Analgesics / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods* / Q000592:standards; D016638:Critical Illness; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005283:Fentanyl / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D004091:Hydromorphone / Q000494:pharmacology / Q000627:therapeutic use; D054542:Iraq War, 2003-2011; D007649:Ketamine / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data; D009020:Morphine / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D014195:Travel / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000700:Analgesics; D007649:Ketamine; D009020:Morphine; D004091:Hydromorphone; D005283:Fentanyl