Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
J Pharm Pract. 2020 Apr;33(2):129-135. doi: 10.1177/0897190018786832. Epub 2018 Jul 11.
The 2013 Society of Critical Care Medicine guidelines for the management of pain, agitation, and delirium in adult intensive care unit (ICU) patients recommend intravenous opioids as first-line therapy to treat nonneuropathic pain. There is a paucity of literature describing possible benefits of utilizing specific opioids over others in ICU patients.
The objective was to identify rationales for the transition from continuous infusion fentanyl to continuous infusion hydromorphone in critically ill patients.
This was a single-center, prospective, observational analysis of adult ICU patients who were transitioned from fentanyl to hydromorphone. The major end point was to characterize the primary reason for transition. Minor end points included secondary reason(s) for transition, transition dosing, changes in continuous sedative requirements, and level of sedation.
Forty-six patients were included in the analysis. The primary rationale for transition was ventilator compliance (28.3%), followed by tachyphylaxis or better pain control (19.6%), and reduction in sedatives (13.0%). The most common secondary reason(s) for transition included reduction in sedatives (47.8%), opioid rotation (32.6%), and obesity (30.4). Median fentanyl rate of 100 µg/h was transitioned to 1 mg/h of hydromorphone. The percentage of patients requiring the use of continuous sedatives was decreased in the 24 hours following transition ( .005); however, patients were more deeply sedated ( = .02).
Rationales for transition were to improve ventilator compliance, optimize patient-specific pharmacokinetics, and limit overall sedative exposure.
2013 年危重病医学会成人重症监护病房（ICU）患者疼痛、躁动和谵妄管理指南建议静脉内使用阿片类药物作为治疗非神经性疼痛的一线治疗药物。目前文献中很少有描述 ICU 患者使用特定阿片类药物优于其他药物的可能益处。
本研究旨在确定从持续输注芬太尼转换为持续输注氢吗啡酮在危重症患者中的合理理由。
这是一项对从芬太尼转换为氢吗啡酮的成年 ICU 患者进行的单中心、前瞻性、观察性分析。主要终点是确定转换的主要原因。次要终点包括转换的次要原因、转换剂量、连续镇静剂需求的变化以及镇静水平。
共纳入 46 例患者进行分析。转换的主要理由是呼吸机顺应性（28.3%），其次是耐药或更好的疼痛控制（19.6%）和镇静剂减少（13.0%）。最常见的次要转换原因包括减少镇静剂（47.8%）、阿片类药物转换（32.6%）和肥胖（30.4%）。中位数为 100µg/h 的芬太尼剂量转换为 1mg/h 的氢吗啡酮。转换后 24 小时内需要使用连续镇静剂的患者比例降低（.005）；然而，患者的镇静程度更深（ =.02）。
转换的理由是改善呼吸机顺应性、优化患者特定药代动力学和限制总体镇静剂暴露。
