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Conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children
Conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children
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摘要：
AIM To describe our institutional experience with conversion from intravenous(IV)fentanyl infusion directly to enteral methadone and occurrence of withdrawal in critically ill mechanically ventilated children exposed to prolonged sedation and analgesia.METHODS With Institutional Review Board approval,we retrospectively studied consecutively admitted invasively mechanically ventilated children(0-18 years)sedated with IV fentanyl infusion>5 d and subsequently converted directly to enteral methadone.Data were obtained on subject demographics,illness severity,daily IV fentanyl and enteral methadone dosing,time to complete conversion,withdrawal scores(WAT-1),pain scores,and need for rescue opioids.Patients were classified as rapid conversion group(RCG)if completely converted≤48 h and slow conversion group(SCG)if completely converted in>48 h.Primary outcome was difference in WAT-1 scores at 7 d.Secondary outcomes included differences in overall pain scores,and differences in daily rescue opioids.RESULTS Compared to SCG(n=21),RCG(n=21)had lower median WAT-1 scores at 7 d(2.5 vs 5,P=0.027).Additionally,RCG had lower overall median pain scores(3 vs 6,P=0.007),and required less median daily rescue opioids(3 vs 12,P=0.003)than SCG.The starting daily median methadone dose was 2.3 times the daily median fentanyl dose in the RCG,compared to 1.1 times in the SCG(P=0.049).CONCLUSION We observed wide variation in conversion from IV fentanyl infusion directly to enteral methadone and variability in withdrawal in critically ill mechanically ventilated children exposed to prolonged sedation.In those children who converted successfully from IV fentanyl infusion to enteral methadone within a period of 48 h,a methadone:fentanyl dose conversion ratio of approximately 2.5:1 was associated with less withdrawal and reduced need for rescue opioids.
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METHADONE
Withdrawal
Children
Intensive
care
PROLONGED
OPIOID
INFUSION
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研究分支
研究去脉
引文网络交叉学科
相关学者/机构
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世界临床儿科杂志
主办单位：
百世登出版集团有限公司
出版周期：
不定期
ISSN：
2219-2808
CN：
开本：
出版地：
北京市朝阳区东四环中路62号楼远洋国际中
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出版文献量（篇）
134
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0
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0
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