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Objectives: The objective of this study was to compare pain control and opioid consumption in critically ill patients who were treated with buprenorphine sublingual or oxycodone oral/enteral during ICU admission., Design: This was a retrospective, parallel, cohort study., Setting: General medical or surgical ICUs of a quaternary, urban hospital in Sydney, NSW, Australia., Patients: Data were obtained for all patients admitted to two general medical or surgical ICU from January 2019 to January 2023. Patients were grouped as those who received buprenorphine sublingual versus oxycodone oral/enteral., Interventions: None., Measurements and Main Results: Pain control was compared between a propensity score matched cohort of patients who received buprenorphine versus oxycodone. The primary outcome was the probability of significant pain. A significant pain score was defined as greater than or equal to 4 on the 0-10 Numeric Rating Scale or greater than or equal to 6 on the Behavioral Pain Scale. The study cohort included 1,070 patients (288 buprenorphine and 782 oxycodone). After propensity score matching, there were 288 patients in each group. The mean age of the matched cohort was 64 ± 16 years, 295 (51%) were male, and 359 (62%) had a surgical admission. The median probability of significant pain was 0.16 with buprenorphine and 0.17 with oxycodone (median difference, 0.01; 95% CI, -0.02 to 0.04; p = 0.50). Median opioid consumption in oral morphine milligram equivalents (MMEs) was 65 with buprenorphine and 70 with oxycodone (median difference, -1 mg; 95% CI, -10 to 10 mg; p = 0.73). Median MME per ICU day was 22 with buprenorphine and 22 with oxycodone (median difference, 1 mg; 95% CI, -2 to 5 mg; p = 0.38)., Conclusions: Buprenorphine sublingual is as effective as oxycodone oral/enteral with regard to pain control and opioid consumption in the ICU. Buprenorphine sublingual is an appropriate option for patients in the ICU who are unable to take oral/enteral medications., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Transdermal buprenorphine (TBUP) may be useful for postoperative pain after major surgery, when pain is expected to be severe and sustained. The objective of this study was to compare pain control and opioid consumption in critically ill postoperative patients who were treated with TBUP or not during ICU admission., Design: This was a retrospective, parallel, cohort study., Setting: ICU of a quaternary, urban hospital in Sydney, Australia., Patients: Data were obtained for all patients admitted to the ICU from January 2019 to July 2021 after major gastrointestinal (GI) or genitourinary (GU) surgery., Interventions: TBUP or non-TBUP., Measurements and Main Results: Pain control was compared between patients who received TBUP and those who did not receive TBUP. The primary outcome was the probability of significant pain. A significant pain score was defined as greater than or equal to 4 on the 0-10 numeric rating scale or greater than or equal to 6 on the behavioral pain scale. Inverse probability of treatment weighting was used to adjust for baseline differences. The cohort included 376 patients, with 224 (60%) in the control group and 152 (40%) in the TBUP group. The mean age was 60 ± 14 years, 202 (54%) were male, mean Acute Physiology and Chronic Health Evaluation III score was 44 ± 13, and 147 (39%) received mechanical ventilation. After adjustment, the median probability of significant pain was 0.25 with control and 0.30 with TBUP (median difference, 0.02; 95% CI, 0.04-0.11; p = 0.44). The median opioid consumption (oral morphine milligram equivalents) per day was 5.7 mg with control and 10.1 mg with TBUP (median difference, 0.4 mg; 95% CI, -0.4 to 3.7 mg; p = 0.31)., Conclusions: In patients who are admitted to the ICU after major GI or GU procedures, the use of TBUP in the ICU was not associated with improved pain control or opioid consumption compared with those who did not receive TBUP., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

Venous thromboembolic disease (VTE) increases the risk of mortality in trauma patients. To decrease the occurrence of VTE, low dose anticoagulants are commonly prescribed. This may be unacceptable in trauma patients who have a high risk of bleeding. Inferior vena cava (IVC) filters can be employed as an alternative strategy to decrease the risk of pulmonary embolism (PE). Insertion of an IVC filter is an invasive procedure that has a range of complications. The benefits of IVC filter insertion must be compared to its risk of complications in each individual patient. A search of the literature since 2005 was conducted on MEDLINE, Evidence-Based Medicine Reviews, Cochrane Central Register of Controlled Trials and Embase. The clinical question posed was does prophylactic IVC filter insertion decrease the risk of PE in trauma patients? The available evidence was low level and unable to definitively answer this question. The majority of articles infer that IVC filter insertion is safe and may decrease the risk of PE. However, there is a need for well-designed randomised controlled trials to be conducted in this area., (© 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Unlabelled: After graft reperfusion in orthotopic liver transplantation (OLT), ischemia reperfusion syndrome (IRS) is characterized by persistent hypotension with a low systemic vascular resistance. Methylene blue (MB) has been used as a vasopressor in sepsis and acute liver failure. We investigated the effect of MB on IRS during OLT. Thirty-six patients undergoing elective OLT were randomized to receive either a bolus of MB 1.5 mg/kg before graft reperfusion, or normal saline (placebo). We recorded hemodynamic variables, postoperative liver function tests, and time to hospital discharge. Blood samples were analyzed for arterial lactate concentration, cyclic 3',5'-monophosphate, and plasma nitrite/nitrate concentrations. The MB group had higher mean arterial pressure (P = 0.035), higher cardiac index (P = 0.04), and less epinephrine requirement (P = 0.02). There was no difference in systemic vascular resistance or central venous pressure. Serum lactate levels were lower at 1 h after reperfusion in MB patients, suggesting better tissue perfusion (P = 0.03). In the presence of MB, there was a reduction in cyclic 3',5'-monophosphate (P < 0.001), but not plasma nitrites. Postoperative liver function tests and time to hospital discharge were the same in both groups. MB attenuated the hemodynamic changes of IRS in OLT acting via guanylate cyclase inhibition., Implications: Methylene blue attenuates the hemodynamic changes of the ischemia reperfusion syndrome in liver transplantation, and this effect involves guanylate cyclase inhibition.