Sedation and analgesia usage in severe pandemic H1N1 (2009) infection: a comparison to respiratory failure secondary to other infectious pneumonias.

BACKGROUND: During the 2009 H1N1 pandemic (pH1N1), patients requiring mechanical ventilation for respiratory failure received high doses of sedation and analgesia. OBJECTIVE: To examine sedation and analgesia use among patients with respiratory failure due to severe pH1N1 infection compared to other infectious pneumonias. METHODS: In this observational cohort study of intensive care unit (ICU) patients with respiratory failure, we compared doses of sedatives and analgesics administered to patients with pH1N1, non-pH1N1 viral pneumonia, and adult respiratory distress syndrome (ARDS) secondary to bacterial pneumonia, on days 1, 3, 7, 14, and 28 of ICU admission. Cumulative drug use, daily drug use, and weight-adjusted medication doses were examined. RESULTS: The study population consisted of 37 patients with pH1N1 infection, 22 patients with non-pH1N1 viral pneumonia, and 46 patients with ARDS secondary to bacterial pneumonia. To achieve similar levels of sedation using the Richmond Agitation Sedation Scale, patients with pH1N1 were administered the highest cumulative median doses of fentanyl (11,230 µg; interquartile range [IQR] 3240-21,000), compared to 2400 µg (IQR 130-7130) in viral pneumonia and 2880 µg (IQR 600-6950) in ARDS (p < 0.001). Patients with pH1N1 were also administered the highest cumulative median doses of midazolam at 820 mg (IQR 330-1160), compared to 160 mg (IQR 20-390) in viral pneumonia and 160 mg (IQR 20-480 mg) in ARDS (p < 0.001). The pH1N1 group received the highest median daily fentanyl and midazolam doses on all study days. The pH1N1 group did not differ significantly in cumulative propofol dose compared with the other 2 study groups. CONCLUSIONS: Sedative and analgesic use may be uniquely higher in critically ill patients with pH1N1 infection compared to patients with other infectious pneumonias. This finding may be important for resource planning in future pandemics. Further study is required to explore the underlying mechanisms for potentially higher sedative and analgesic requirements in this patient population.

Trauma Exposure, DSM-5 Posttraumatic Stress, and Binge Eating Symptoms: Results From a Nationally Representative Sample.

OBJECTIVE: To evaluate the association between trauma exposure type, number and type of DSM-5 posttraumatic stress disorder (PTSD) symptoms, and binge eating symptoms. METHODS: Data were analyzed from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III: 2012-2013), which surveyed a nationally representative sample of 36,309 non-institutionalized US civilians aged 18 years and older. Trauma exposure, PTSD, and binge eating symptoms were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule, DSM-5 Version (AUDADIS-5). Three groups were compared: trauma-exposed individuals with no/low PTSD symptoms, those with subthreshold PTSD, and those with threshold PTSD. RESULTS: Among both men and women, zero-inflated negative binomial regression analyses demonstrated that individuals with subthreshold and threshold PTSD endorsed a greater number of binge eating symptoms than trauma-exposed individuals with no/low PTSD symptoms (unstandardized coefficient [B] range, 0.33-0.92). Relative to witnessing trauma, combat-related trauma was associated with fewer binge eating symptoms in men (B = -0.62, SE = 0.17), while child maltreatment was associated with a greater number of binge eating symptoms in women (B = 0.28, SE = 0.12). Negative cognitions and mood symptoms in particular were associated with a greater number of binge eating symptoms (B range, 0.09-0.10). CONCLUSIONS: Subthreshold and threshold PTSD are associated with binge eating symptoms in both men and women. Similar to drugs and alcohol, binge eating may be used as a strategy to alleviate distressing symptoms of PTSD.