Cargando…
Conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children
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 ap...
Autores principales: | , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424279/ https://www.ncbi.nlm.nih.gov/pubmed/28540195 http://dx.doi.org/10.5409/wjcp.v6.i2.110 |
_version_ | 1783235097333334016 |
---|---|
author | Srinivasan, Vijay Pung, Daniel O’Neill, Sean P |
author_facet | Srinivasan, Vijay Pung, Daniel O’Neill, Sean P |
author_sort | Srinivasan, Vijay |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-5424279 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-54242792017-05-24 Conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children Srinivasan, Vijay Pung, Daniel O’Neill, Sean P World J Clin Pediatr Retrospective Study 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. Baishideng Publishing Group Inc 2017-05-08 /pmc/articles/PMC5424279/ /pubmed/28540195 http://dx.doi.org/10.5409/wjcp.v6.i2.110 Text en ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Retrospective Study Srinivasan, Vijay Pung, Daniel O’Neill, Sean P Conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children |
title | Conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children |
title_full | Conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children |
title_fullStr | Conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children |
title_full_unstemmed | Conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children |
title_short | Conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children |
title_sort | conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children |
topic | Retrospective Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424279/ https://www.ncbi.nlm.nih.gov/pubmed/28540195 http://dx.doi.org/10.5409/wjcp.v6.i2.110 |
work_keys_str_mv | AT srinivasanvijay conversionfromprolongedintravenousfentanylinfusiontoenteralmethadoneincriticallyillchildren AT pungdaniel conversionfromprolongedintravenousfentanylinfusiontoenteralmethadoneincriticallyillchildren AT oneillseanp conversionfromprolongedintravenousfentanylinfusiontoenteralmethadoneincriticallyillchildren |