Observation and Study on the Application of Different Analgesic Regimens in Critically Ill Patients Without Mechanical Ventilation

Pain management is a critical component of treatment for critically ill patients, particularly in non-mechanically ventilated patient populations. Appropriate analgesic therapy not only impacts patient comfort but also directly influences disease outcomes and medical safety. Non-ventilated patients often endure moderate-to-severe pain due to conditions such as postoperative trauma, advanced cancer, and acute pancreatitis. Pain-induced stress responses can lead to tachycardia, hypertension, increased oxygen consumption, and immunosuppression. Studies indicate that inadequately controlled acute pain increases myocardial infarction risk by 2.3-fold and deep vein thrombosis incidence by 1.8-fold, with strong correlations to chronic pain persistence.

However, implementing analgesic therapy faces dual challenges:

1. Pain assessment tends to be delayed in patients with impaired consciousness or communication difficulties, resulting in undertreatment; 2. Analgesic drugs carry complex side-effect profiles, with opioid-associated respiratory depression occurring in 9%-12% of cases, and NSAIDs increasing gastrointestinal bleeding risk by 4.7-fold. These complications may have catastrophic consequences in non-ventilated patients. Taking respiratory depression as an example: non-ventilated patients lack artificial airway protection. Even mild reductions in respiratory rate can cause hypercapnia, potentially necessitating emergency intubation. Mortality rates among these emergently intubated patients are 3.2 times higher than those with planned intubation\[3\]. This therapeutic dilemma makes precise analgesic regimen selection a core clinical challenge.Notably, the novel analgesic hydromorphone-a semi-synthetic morphine derivative-exhibits 8-10 times greater analgesic potency than morphine with a non-ceiling effect. It offers rapid onset, non-toxic metabolites, and diverse administration routes, demonstrating superior clinical applicability especially in patients with hepatic/renal impairment. Preliminary studies suggest hydromorphone significantly reduces respiratory depression and gastrointestinal adverse events compared to traditional opioids. Nevertheless, clinical data in non-ventilated patients remain limited, warranting systematic evaluation.

• Total dosage of analgesics [Time frame: The observation period starts from patient enrollment and lasts for 7 days or until transfer out of the intensive care unit (ICU).]
• incidence of adverse events (including but not limited to cardiovascular/respiratory depression, delayed gastrointestinal motility recovery, nausea/vomiting, and pruritus) [Time frame: The observation period starts from patient enrollment and lasts for 7 days or until transfer out of the intensive care unit (ICU).]
• in-hospital/ICU mortality [Time frame: The observation period starts from patient enrollment and lasts for 7 days or until transfer out of the intensive care unit (ICU).]
• length of hospital stay, and ICU length of stay [Time frame: The observation period starts from patient enrollment and lasts for 7 days or until transfer out of the intensive care unit (ICU).]