Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) use in the Critically Ill: A Scoping Review

Abstract

Opioids and other analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) are important medications for pain management; however, the use of these agents raises important adverse effect concerns in critically ill patients already predisposed to organ dysfunction. Pain medication properties that apply to an otherwise healthy individual with pain may or may not translate to the critically ill. Appropriate patient selection with ongoing monitoring for drug efficacy and adverse effects can help optimize the benefit: risk consideration. Opioids are a staple of pain management in the acute care setting but have well known adverse effects including constipation, central nervous system and respiratory depression, and opioid use disorder with prolonged inappropriate use. Because of these adverse effect concerns of opioids, current clinical practice guidelines pertaining to critically ill patients recommend the use of opioid-sparing therapies such as NSAIDs. Some of the NSAID adverse effects of most concern in the critically ill population include gastrointestinal bleeding and acute kidney injury. These adverse effects of NSAIDs may be masked or amplified in critically ill patients prone to variable and compromised health states during their intensive care unit (ICU) stay. The purpose of this scoping review is to conduct a thorough search of the current literature concerning NSAID adverse effects in critically ill patients. Our aim is to collect data on the rate and types of NSAID adverse effects in this patient population in order to help guide therapy recommendations and monitoring parameters. We also intend to provide information on gaps in the literature to guide further research and clinical decision making concerning NSAID use in critically ill patients.