Large Language Models for Opioid-Induced Respiratory Depression Prediction in Hospitalized Patients: A Retrospective Study

ACM Transactions on Computing for Healthcare, Год журнала: 2025, Номер unknown

Опубликована: Март 20, 2025

Opioid-induced adverse events pose significant risks to hospitalized patients. However, there is a limited understanding of which patients on general care floors are at risk for opioid-induced respiratory depression (OIRD). This study aims bridge that knowledge gap by utilizing the advancements artificial intelligence (AI) interpret electronic medical records (EMRs). Recently, large language models (LLMs) have gained attention their exceptional capabilities in human language, makes them crucial AI systems healthcare focus clinical narratives. In this study, we extracted 2,663 adult patient from UC Davis Medical Center archives between January 2010 April 2020 identify high OIRD. For purpose, employed (BioBERT, ClinicalBERT, and GatorTron) fine-tuned OIRD dataset. Additionally, leveraged GPT-4, state-of-the-art LLM, select most informative factors enhance accuracy predictive models.

Язык: Английский

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Opioid-Sparing Effects of Erector Spinae Plane Block in Off-Pump Coronary Artery Bypass Grafting with Median Sternotomy: A Randomized Controlled Trial

Cardiovascular Drugs and Therapy, Год журнала: 2025, Номер unknown

Опубликована: Апрель 14, 2025

Язык: Английский

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Fentanyl blockade of K+ channels contribute to Wooden Chest Syndrome

bioRxiv (Cold Spring Harbor Laboratory), Год журнала: 2025, Номер unknown

Опубликована: Янв. 18, 2025

Abstract Fentanyl is a potent synthetic opioid widely used perioperatively and illicitly as drug of abuse 1,2 . It well established that fentanyl acts μ-opioid receptor agonist, signaling through Gα i/o intracellular pathways to inhibit electrical excitability, resulting in analgesia respiratory depression 3,4 However, uniquely also triggers muscle rigidity, including muscles, hindering the ability execute central commands or receive external resuscitation. This potentially lethal condition termed Wooden Chest Syndrome (WCS), mechanisms which are poorly understood 5–7 Here we show directly blocks subset EAG-class potassium channels 8 Our results demonstrate these expressed cervical spinal motoneurons, those innervating diaphragm. A significant fraction motoneurons excited by fentanyl, concomitant with blockade voltage-dependent non-inactivating K + currents In vivo electromyography revealed persistent tonic component diaphragmatic activity elicited but not morphine. Taken together our identify novel off-target mechanism for action, independent activation, paradoxical excitatory effect may underlie WCS. We anticipate findings inform design safer analgesics generalize other neuronal circuits implicated fentanyl-related maladaptive behaviors.

Язык: Английский

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Peripheral opioid receptor antagonism alleviates fentanyl-induced cardiorespiratory depression and is devoid of aversive behavior

Опубликована: Март 17, 2025

Millions of Americans suffering from Opioid Use Disorders (OUD) face a high risk fatal overdose due to opioid-induced respiratory depression (OIRD). Fentanyl, powerful synthetic opioid, is major contributor the rising rates deaths. Reversing fentanyl overdoses has proved challenging its potency and rapid onset OIRD. We assessed contributions central peripheral mu opioid receptors (MORs) in mediating fentanyl-induced physiological responses. The peripherally restricted MOR antagonist naloxone methiodide (NLXM) both prevented reversed OIRD degree comparable that (NLX), indicating substantial involvement MORs Interestingly, NLXM-mediated reversal did not produce aversive behaviors observed after NLX. show neurons nucleus solitary tract (nTS), first synapse afferents, exhibit biphasic activity profile following exposure. NLXM pretreatment attenuates this activity, suggesting these responses are mediated by MORs. Together, findings establish critical role for MORs, including ascending inputs nTS, as sites dysfunction during Furthermore, selective antagonism could be promising therapeutic strategy managing sparing CNS-driven acute opioid-associated withdrawal aversion

Язык: Английский

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Dyspnea management in palliative care: current approaches and treatment strategies

Journal of Medicine and Palliative Care, Год журнала: 2025, Номер 6(2), С. 167 - 173

Опубликована: Март 23, 2025

Dyspnea is a common and challenging symptom to manage in palliative care patients. This review discusses the pathophysiology, assessment methods, current treatment approaches for dyspnea based on existing literature. Both pharmacological (opioids, benzodiazepines, glucocorticoids) non-pharmacological (oxygen therapy, respiratory environmental modifications) strategies are examined detail, with discussion their efficacy potential side effects. study narrative compiling literature topic.

Язык: Английский

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Two doses of Qβ virus like particle vaccines elicit protective antibodies against heroin and fentanyl

npj Vaccines, Год журнала: 2025, Номер 10(1)

Опубликована: Март 28, 2025

Opioid overdoses and opioid use disorder (OUD) are major public health concerns. Current treatment approaches for OUD have failed to slow the growth of crisis. vaccines shown pre-clinical success in targeting multiple different drugs. However, need many immunizations can limit their clinical implementation. In this study, we investigate development novel by independently fentanyl active metabolites heroin using a bacteriophage virus-like particle (VLP) vaccine platform. We establish successful conjugation haptens Qβ VLPs demonstrate immunogenicity Qβ-fentanyl, Qβ-morphine, Qβ-6-acetylmorphine animal models after one or two immunizations. show that these elicit high-titer, high-avidity, durable antibody responses. Moreover, reveal protective capacities against challenge Overall, findings Qβ-VLP conjugated as promising candidates.

Язык: Английский

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Respiratory depression in women receiving propofol/esketamine versus propofol/fentanyl for abortion surgery or curettage: a randomized clinical trial

Annals of Medicine, Год журнала: 2025, Номер 57(1)

Опубликована: Апрель 2, 2025

A combination of opioids with propofol is a popular approach to non-intubated general anaesthesia; however, this method usually results in higher incidence respiratory depression. We compared the esketamine- and fentanyl-induced depression women undergoing abortion surgery or curettage under propofol-based anaesthesia. This study included 176 (aged 18-60 years) scheduled for curettage. Patients were randomized into fentanyl esketamine groups. group received (1 µg/kg) combined intravenously. subanaesthetic doses (0.15 mg/kg) The primary outcome was during Secondary outcomes rate, pulse oximetry, blood pressure, heart dose, duration surgery, anaesthesia, adverse events. significantly lower than that (11% vs. 45%; p < .0001). Propofol administration fentanyl. Respiratory SpO2 pressure more stable group. incidences hypotension, propofol-induced injection pain chin lifting those nightmares anaesthesia.KEY MESSAGESOpioids depression.At doses, provides an analgesic effect by antagonizing N-methyl-d-aspartate receptor.In trial,

Язык: Английский

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Naloxone dosing by non-medical first-responders at opioid overdoses: findings from a qualitative interview study

Harm Reduction Journal, Год журнала: 2025, Номер 22(1)

Опубликована: Апрель 18, 2025

Язык: Английский

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L-NAC reverses of the adverse effects of fentanyl infusion on ventilation and blood-gas chemistry

Biomedicine & Pharmacotherapy, Год журнала: 2022, Номер 153, С. 113277 - 113277

Опубликована: Июнь 17, 2022

There is an urgent need for development of drugs that are able to reverse the adverse effects opioids on breathing and arterial blood-gas (ABG) chemistry while preserving opioid analgesia. The present study describes bolus injections N-acetyl-L-cysteine (L-NAC, 500 μmol/kg, IV) ventilatory parameters, ABG chemistry, Alveolar-arterial (A-a) gradient, sedation (righting reflex) analgesia status (tail-flick latency assay) in unanesthetized adult male Sprague Dawley rats receiving a continuous infusion fentanyl (1 μg/kg/min, IV). Fentanyl elicited pronounced disturbances (1) parameters (e.g., decreases frequency breathing, tidal volume minute ventilation), (2) (decreases pH, pO

Язык: Английский

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Fentanyl effects on respiratory neuron activity in the dorsolateral pons

Journal of Neurophysiology, Год журнала: 2022, Номер 128(5), С. 1117 - 1132

Опубликована: Окт. 5, 2022

Opioids can suppress breathing via actions throughout the brainstem, including dorsolateral pons. The respiratory phenotype of pontine neurons inhibited by opioids is unknown. Here, we describe effect highly potent opioid fentanyl on firing activity these neurons. Inspiratory were largely silenced fentanyl, whereas expiratory not. We provide a framework whereby this differential sensitivity to contribute pattern deficits and apnea.

Язык: Английский

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