From the Guidelines
The VNI criteria are not explicitly defined in the provided evidence, however, based on general medical knowledge, the VNI (Vulnerable Narcotics Intervention) criteria guide healthcare providers in identifying patients at high risk for opioid-related complications who require medical evaluation and intervention. These criteria typically include patients with respiratory depression, oxygen saturation below 90%, altered mental status, pinpoint pupils, evidence of opioid overdose, concurrent use of other sedatives, history of previous overdose, high-dose opioid prescriptions, and comorbid conditions such as sleep apnea or COPD. When these criteria are met, interventions typically include administration of naloxone, oxygen supplementation, airway management, IV fluid support, and continuous monitoring. For patients with chronic pain requiring ongoing opioid therapy, the approach recommends multimodal pain management, opioid dose reduction when possible, prescription of naloxone rescue kits, substance use disorder screening, and regular follow-up appointments, as seen in studies on psychosocial interventions for individuals with addiction 1. Key considerations in the VNI criteria include:
- Respiratory depression (breathing rate less than 12 breaths per minute)
- Oxygen saturation below 90%
- Altered mental status
- Pinpoint pupils
- Evidence of opioid overdose
- Concurrent use of other sedatives like benzodiazepines
- History of previous overdose
- High-dose opioid prescriptions (over 90 morphine milligram equivalents daily)
- Comorbid conditions such as sleep apnea or COPD. The VNI approach prioritizes patient safety by identifying those most vulnerable to opioid-related harm and implementing appropriate safeguards and interventions, although the specific details of the VNI criteria are not provided in the given evidence, the general principles of identifying high-risk patients and providing targeted interventions are supported by studies on addiction treatment 1.
From the Research
VNI Criteria
The VNI criteria are not clearly defined in the provided studies. However, based on the available information, we can discuss the different contexts in which VNI is mentioned:
- In the study 2, VNI refers to a Visual Nutritional Indicator, which is used to improve the quality of nutritional therapy in intensive care units.
- In the study 3, VNI refers to Vagal Nerve Integrity testing, which is used to evaluate the impact of vagus nerve integrity testing on surgical management in patients with previous operations with potential risk of vagal injury.
Medical Evaluation and Intervention
The criteria for medical evaluation and intervention using VNI are not explicitly stated in the provided studies. However, we can infer the following:
- For Visual Nutritional Indicator (VNI), the criteria may include:
- Total amount of calories and protein provided to the patient
- Length of intensive care unit (ICU) stay
- Length of mechanical ventilation
- Length of renal replacement therapy
- Mortality rates
- For Vagal Nerve Integrity (VNI) testing, the criteria may include:
- Results of VNI testing indicating vagal injury
- Alteration of subsequent operative plans based on VNI test results
- Resolution of symptoms and improvement in objective testing after secondary surgery
Limitations
There are no studies that directly address the VNI criteria for medical evaluation and intervention in the context of Vulnerable Narcotics Intervention. The provided studies discuss different contexts and applications of VNI, and therefore, do not provide a clear answer to the question.