Robertson R C, Darsey E, Fortenberry J D, Pettignano R, Hartley G
Critical Care Division, Children's Healthcare of Atlanta at Egleston, GA 30322, USA.
Pediatr Crit Care Med. 2000 Oct;1(2):119-23. doi: 10.1097/00130478-200010000-00005.
To evaluate the efficacy of a standardized opiate-weaning protocol using methadone compared with methadone weaning before protocol development.
Time series, prospective study with comparison to historical controls.
Twenty-bed medical-surgical intensive care unit in an academic children's hospital.
Ten children, aged 6 months to 18 yrs, who received methadone for weaning from continuous opiate infusions for >or=7 days compared with ten patients undergoing weaning by standardized protocol.
Institution of standardized opiate-weaning protocol.
Patient age, gender, and diagnosis were similar in both nonprotocol (NP) and protocol (P) groups (p = NS). Days of opiate use were also similar between groups. Nine of ten NP and seven of ten P patients were on continuous fentanyl infusions, and the remainder were on continuous morphine infusions. P patients were weaned significantly faster than NP patients (median, 9 days and 20 days, respectively; p <.001). P patients requiring short-term opiate use also weaned significantly faster than short-term NP patients (median, 5 days and 21.5 days, respectively; p <.001). Withdrawal complications were seen in three NP patients with weaning delayed in two. Two P patients had withdrawal complications with no delay in weaning (p = NS). Significant methadone calculation discrepancy occurred in one NP patient but in no P patients.
Pediatric intensive care unit patients requiring prolonged opiate use can be weaned by using methadone with minimal signs of withdrawal. Use of a standardized weaning protocol decreased time for weaning without increasing the frequency rate of withdrawal symptoms.
