KETOROlac at Lower reduced doses for Analgesic pain Control in ICU (KETOROLAC-ICU)

A mainstay of analgesia provision for critically ill patients has been opiates for pain control. Prior observational studies demonstrate that over 80% of mechanically ventilated patients use opiates. However, opiate use can be fraught with side effects including: delirium, constipation, hypopneas/apnea. Increased rates of opiate use in hospital lead to increased prescription-based opiate dependence following intensive care unit (ICU) discharge. This may contribute to the ongoing opiate epidemic across the world with increased tolerance and addiction to these medications, with potential consequences of higher opiate related overdoses.

Other adjunctive medications exist, including non-steroidal anti-inflammatory drugs (NSAIDs) which block cyclooxygenases (COX) and this can work to block decrease pain, fever and inflammation. Traditionally, NSAIDs have been avoided in ICU patients due to the theoretical increased risk of gastrointestinal (GI) bleeding and risk of acute kidney injury (AKI). It is unclear whether patients, families and ICU healthcare providers consider opiate use reduction a patient-important outcome.

Because of this, we are proposing a qualitative study using a modified Delphi approach to learn if opiate use reduction using other analgesic adjuncts in adult critically ill patients is a patient-important outcome.