Implementation of a risk-stratified opioid weaning protocol in a pediatric intensive care unit

被引:18
作者
Sanchez-Pinto, L. Nelson [1 ]
Nelson, Lara P. [2 ]
Phuong Lieu [3 ]
Koh, Joyce Y. [4 ]
Rodgers, John W. [4 ]
Larson, Krichelle A. [3 ]
Huson, Jennifer M. [3 ]
Amirnovin, Rambod [2 ]
机构
[1] Ann & Robert H Lurie Childrens Hosp Chicago, Div Crit Care Med, 225 E Chicago Ave,Box 73, Chicago, IL 60611 USA
[2] Childrens Hosp Los Angeles, Dept Anesthesiol & Crit Care Med, 4650 Sunset Blvd, Los Angeles, CA 90027 USA
[3] Childrens Hosp Los Angeles, Patient Care Serv, 4650 Sunset Blvd, Los Angeles, CA 90027 USA
[4] Childrens Hosp Los Angeles, Div Hosp Med, Dept Pediat, 4650 Sunset Blvd, Los Angeles, CA 90027 USA
关键词
Opioids; Withdrawal syndrome; Risk assessment; Pediatrics; Critical care; Clinical protocol; CHILDREN; SEDATION; MANAGEMENT; DELIRIUM; TRIAL;
D O I
10.1016/j.jcrc.2017.08.049
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose: Opioids are important in the care of critically ill children. However, their use is associated with complications including delirium, dependence, withdrawal, and bowel dysfunction. Our aim was to implement a risk-stratified opioid weaning protocol to reduce the duration of opioids without increasing the incidence of withdrawal. Methods: A pre- and post-interventional prospective study was undertaken in a large children's hospital pediatric ICU where we implemented a risk-stratified opioid weaning protocol. Patients were included if exposed to >= 7 days of scheduled opioids. The primary outcome was duration of opioids and secondary outcome was hospital LOS. Results: One hundred seven critically ill children met the inclusion criteria (68 pre-, 39 post-intervention). Demographics, risk factors, and confounders did not differ between groups. Patients in the post-intervention group had shorter duration of opioids (17 vs. 22.5 days, p = 0.01) and opioid wean (12 vs. 18 days, p = 0.01). Despite the shorter duration of opioid wean, there was no increase in withdrawal incidence. There was no difference in the LOS (29 vs. 33 days, p = 0.06). Conclusions: We implemented a risk-stratified opioid weaning protocol for critically ill children that resulted in reduction in opioid exposure without an increase in withdrawal. There was no difference in the LOS. (C) 2017 Elsevier Inc. All rights reserved.
引用
收藏
页码:214 / 219
页数:6
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