Wilson Alexandra K, Ragsdale Carolyn E, Sehgal Ila, Vaughn Micah, Padilla-Tolentino Eimeira, Barczyk Amanda N, Lawson Karla A
J Pediatr Pharmacol Ther. 2021;26(1):42-49. doi: 10.5863/1551-6776-26.1.42. Epub 2021 Jan 4.
Determine if a standardized methadone and lorazepam weaning protocol that is based on dose and duration of exposure can reduce the length of opioid and benzodiazepine weaning and shorten hospital stay.
Retrospective cohort study performed in a 24-bed medical/surgical PICU. A total of 177 patients on opioid and/or benzodiazepine infusions for >3 days were included; 75 patients pre protocol (June 2012- June 2013) were compared with 102 patients post implementation of a standardized weaning protocol of methadone and lorazepam (March 2014-March 2015). The recommended wean was based on duration of infusions of >3 days up to 5 days (no wean), 5 to 13 days (short wean), and ≥14 days (long wean).
Median number of days on methadone for patients on opioid infusions for 5 to 13 days was reduced from 8.5 to 5.7 days (p = 0.001; n = 45 [pre], n = 68 [post]) and for patients on opioid infusions for ≥14 days, from 29.7 to 11.5 days (p = 0.003; n = 9 [pre], n = 9 [post]) after protocol implementation. The median number of days on lorazepam for patients on benzodiazepine infusions for 5 to 13 days was reduced from 8.1 to 5.2 days (p = 0.020; n = 43 [pre], n = 55 [post]) and for patients on benzodiazepine infusions for ≥14 days, from 27.4 to 9.3 days (p = 0.011; n = 9 [pre], n = 8 [post]). There was no difference in methadone or lorazepam wean length for patients on 3 to 5 days of infusions. There was no difference in adverse events or hospital length of stay.
A methadone and lorazepam weaning protocol based on patient's exposure to opioids and benzodiazepines (dose and duration) reduces weaning length.
确定一种基于暴露剂量和持续时间的标准化美沙酮和劳拉西泮戒断方案是否能缩短阿片类药物和苯二氮䓬类药物的戒断时间并缩短住院时间。
在一家拥有24张床位的内科/外科重症监护病房（PICU）进行回顾性队列研究。纳入了总共177名接受阿片类药物和/或苯二氮䓬类药物输注超过3天的患者；将75名方案实施前（2012年6月至2013年6月）的患者与102名实施美沙酮和劳拉西泮标准化戒断方案后（2014年3月至2015年3月）的患者进行比较。推荐的戒断方案基于输注持续时间超过3天至5天（不戒断）、5至13天（短程戒断）和≥14天（长程戒断）。
在方案实施后，接受阿片类药物输注5至13天的患者美沙酮使用天数中位数从8.5天降至5.7天（p = 0.001；n = 45[实施前]，n = 68[实施后]），接受阿片类药物输注≥14天的患者，美沙酮使用天数中位数从29.7天降至11.5天（p = 0.003；n = 9[实施前]，n = 9[实施后]）。接受苯二氮䓬类药物输注5至13天的患者劳拉西泮使用天数中位数从8.1天降至5.2天（p = 0.020；n = 43[实施前]，n = 55[实施后]），接受苯二氮䓬类药物输注≥14天的患者，劳拉西泮使用天数中位数从27.4天降至9.3天（p = 0.011；n = 9[实施前]，n = 8[实施后]）。输注3至5天的患者在美沙酮或劳拉西泮戒断时间上没有差异。不良事件或住院时间没有差异。
基于患者对阿片类药物和苯二氮䓬类药物的暴露情况（剂量和持续时间）的美沙酮和劳拉西泮戒断方案可缩短戒断时间。
