A hospital is meant to be a safe haven for patients, and Dr. Sunil Sharma understands it’s his job to keep it that way — which is why a nagging suspicion led the section chief of Pulmonary, Critical Care and Sleep Medicine and director of the WVU Medical Intensive Care Unit and Pulmonary and Sleep Medicine Program Development to conduct a year-long study after sending enough people with respiratory failure to ICU, often in the middle of the night.
He had a feeling that the opioids patients were prescribed for various issues — from rheumatoid arthritis to back pain — may have something to do with it.
Under his direction, a team of researchers found that 26 percent of high-risk patients with heart failure and undiagnosed sleep apnea who received opioids required urgent transfer to an ICU as opposed to only 4 percent of those not receiving opioids. The study, he said, shines light on the lesser-known impacts of the opioid epidemic, including the impact of narcotics in hospitalized patients.
“Narcotics, not just outside the hospital, but inside can be dangerous. A lot of folks miss that point. … I was quite surprised that it was 25 percent,” he said of the study’s findings. “It’s a big educational opportunity and a good point to share with the rest of the country, not only the patients themselves but also doctors.”
He said the issue is not only easy to recognize, but to rectify.
When at home, these patients can tolerate a small dose of opioids, but when they are sick and admitted to the hospital even a small dose of the drugs may push those with heart failure and sleep apnea over the edge into respiratory failure by compromising their breathing. So, he said, doctors need to “not brush it off as a regular medication.”
It should be clearly indicated on a chart when patients are taking narcotics. And orders that get placed for any such medication while the patient is at the hospital must first be approved by a doctor, instead of given on an as-needed basis. If a patient is in enough pain to warrant the medication, he said they can be put on non-invasive ventilation — essentially an oxygen mask — to ensure they continue to breathe.
“Physicians admitting patients with heart failure should be aware of the high prevalence of sleep apnea and screen these patients for the condition,” Sharma added. “Opioids should be avoided in these high-risk patients. If alternative medications do not work and opioids are necessary, respiratory support in terms of non-invasive ventilation and close monitoring with continuous measurement of oxygen levels in the blood should be considered.
“These are easily and readily available tools, not just in a university setting, but in small, suburban hospitals.”
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