From the Department of Pharmacy, Mayo Clinic, Rochester, Minnesota.
PGY2 Critical Care Pharmacy Resident at Nebraska Medicine.
ASAIO J. 2021 Apr 1;67(4):443-448. doi: 10.1097/MAT.0000000000001253.
Fentanyl is commonly used in critically ill patients receiving extracorporeal membrane oxygenation (ECMO). Fentanyl's lipophilicity and protein binding may contribute to a sequestration of the drug in the ECMO circuit. Hydromorphone lacks these characteristics potentially leading to a more predictable drug delivery and improved pain and sedation management among ECMO patients. This study compared hydromorphone to fentanyl in patients receiving ECMO. This retrospective study included adult patients receiving ECMO for ≥48 hours. Patients were excluded if they required neuromuscular blockade, received both fentanyl and hydromorphone during therapy, or had opioid use before hospitalization. Baseline characteristics included patient demographics, ECMO indication and settings, and details regarding mechanical ventilation. The primary outcome was opioid requirements at 48 hours post cannulation described in morphine milligram equivalent (MME). Secondary endpoints included 24-hour opioid requirements, concurrent sedative use, and differences in pain and sedation scores. No differences were noted between the patients receiving fentanyl (n = 32) or hydromorphone (n = 20). Patients receiving hydromorphone required lower MME compared to fentanyl at 24 hours (88 [37-121] vs. 131 [137-227], p < 0.01) and 48 hours (168 [80-281] vs. 325 [270-449], p < 0.01). The proportion of within-goal pain and sedation scores between groups was similar at 24 and 48 hours. Sedative requirements did not differ between the groups. Patients receiving hydromorphone required less MME compared to fentanyl without any differences in sedative requirements, or agitation-sedation scores at 48 hours. Prospective studies should be completed to validate these findings.
芬太尼常用于接受体外膜肺氧合 (ECMO) 的危重病患者。芬太尼的亲脂性和蛋白结合可能导致药物在 ECMO 回路中被隔离。氢吗啡酮缺乏这些特性，可能导致更可预测的药物输送，并改善 ECMO 患者的疼痛和镇静管理。本研究比较了氢吗啡酮和芬太尼在接受 ECMO 的患者中的应用。这项回顾性研究纳入了接受 ECMO 治疗时间≥48 小时的成年患者。如果患者需要神经肌肉阻滞剂、治疗期间同时接受芬太尼和氢吗啡酮、或在住院前使用过阿片类药物，则将其排除在外。基线特征包括患者人口统计学、ECMO 适应证和设置以及机械通气的详细信息。主要结局是在插管后 48 小时内用吗啡毫克当量 (MME) 描述的阿片类药物需求。次要终点包括 24 小时内的阿片类药物需求、同时使用镇静剂以及疼痛和镇静评分的差异。接受芬太尼 (n = 32) 或氢吗啡酮 (n = 20) 的患者之间没有差异。与芬太尼相比，接受氢吗啡酮的患者在 24 小时 (88 [37-121] 对 131 [137-227]，p < 0.01) 和 48 小时 (168 [80-281] 对 325 [270-449]，p < 0.01) 时需要的 MME 更少。两组在 24 小时和 48 小时时达到目标的疼痛和镇静评分的比例相似。两组之间镇静剂需求没有差异。与芬太尼相比，接受氢吗啡酮的患者需要更少的 MME，而镇静剂需求或激惹-镇静评分在 48 小时时没有差异。应完成前瞻性研究以验证这些发现。
