Oklahoma Children's Hospital at OU Health, Oklahoma City, OK, USA.
University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA.
Ann Pharmacother. 2021 Dec;55(12):1439-1446. doi: 10.1177/10600280211003170. Epub 2021 Mar 20.
Opioid rotations from fentanyl to hydromorphone may reduce opioid/sedative exposure in critically ill children.
The primary objective was to determine the conversion percentage from fentanyl to hydromorphone infusions using equianalgesic conversions (0.1 mg fentanyl = 1.5 mg hydromorphone). Secondary objectives included identification of the median time and hydromorphone rate at stabilization (defined as the first 24-hour period no hydromorphone rates changed, 80% of State Behavioral Scale [SBS] scores between 0 and -1, and <3 hydromorphone boluses administered). Additional outcomes included a comparison of opioid/sedative requirements on the day of conversion versus the three 24-hour periods prior to conversion.
This retrospective study included children <18 years old converted from fentanyl to hydromorphone infusions over 6.3 years. Linear mixed models were used to determine if the mean cumulative opioid/sedative dosing differed from the day of conversion versus three 24-hour periods prior to conversion.
A total of 36 children were converted to hydromorphone. The median conversion percentage of hydromorphone was 86% of their fentanyl dose (interquartile range [IQR] = 67-100). The median hydromorphone rate at stabilization was 0.08 mg/kg/h (IQR = 0.05-0.1). Eight (22%) were stabilized on their initial hydromorphone rate; 8 (22%) never achieved stabilization. Patients had a significant decrease in opioid dosing on the day of conversion versus the 24-hour period prior to conversion but no changes in sedative dosing following conversion.
A median 14% fentanyl dose reduction was noted when transitioning to hydromorphone. Further exploration is needed to determine if opioid rotations with hydromorphone can reduce opioid/sedative exposure.
从芬太尼转为氢吗啡酮可能会减少危重症儿童的阿片类药物/镇静剂暴露。
主要目的是使用等效镇痛转换（0.1 毫克芬太尼= 1.5 毫克氢吗啡酮）确定从芬太尼转为氢吗啡酮输注的转换百分比。次要目标包括确定稳定（定义为第一个 24 小时期间没有改变氢吗啡酮的速度，80%的州行为量表[SBS]评分在 0 到-1 之间，<3 次给予氢吗啡酮冲击剂量）的中位数时间和氢吗啡酮速度。其他结果包括比较转换日与转换前三个 24 小时期间的阿片类药物/镇静剂需求。
这项回顾性研究包括在 6.3 年内从芬太尼转为氢吗啡酮输注的<18 岁儿童。线性混合模型用于确定累积阿片类药物/镇静剂剂量是否与转换日与转换前三个 24 小时期间不同。
共有 36 名儿童转为氢吗啡酮。氢吗啡酮的中位数转换百分比为其芬太尼剂量的 86%（四分位距[IQR]=67-100）。稳定时的中位数氢吗啡酮速度为 0.08mg/kg/h（IQR=0.05-0.1）。8 名（22%）患者以初始氢吗啡酮速度稳定；8 名（22%）从未稳定。与转换前的 24 小时相比，患者在转换日的阿片类药物剂量显著减少，但在转换后镇静剂剂量没有变化。
当转为氢吗啡酮时，芬太尼剂量减少了中位数 14%。需要进一步探索是否可以通过使用氢吗啡酮进行阿片类药物轮换来减少阿片类药物/镇静剂暴露。
