Adverse effects of nonsteroidal anti-inflammatory drugs in critically ill patients: A scoping review.

This scoping review examines the association between nonsteroidal anti-inflammatory drugs (NSAIDs) and serious adverse events, particularly gastrointestinal (GI) bleeding and acute kidney injury (AKI), in adult critically ill patients. The review found no studies involving heterogeneous critically ill populations in nonspecialty intensive care units; most available research focused on perioperative patients and provided limited safety data, especially regarding serious NSAID-related adverse effects. Given the insufficient evidence and the predisposition of critically ill patients to complications like GI bleeding and AKI, the review supports current clinical guidelines recommending avoidance of sustained NSAID dosing in critically ill patients regardless of cyclooxygenase (COX) selectivity. When NSAIDs are considered for single or short-term use in this population, careful patient selection and monitoring are advised, and future robust randomized controlled trials are needed to clarify NSAID safety in critically ill patients.