Transition From Continuous Infusion Fentanyl to Hydromorphone in Critically Ill Patients

Journal of Pharmacy Practice
Mary P KovacevicJeremy R DeGrado

Abstract

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...Continue Reading

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Citations

Jan 26, 2021·Critical Care Explorations·Mary P KovacevicJeremy R DeGrado
Apr 23, 2021·The Annals of Pharmacotherapy·Diane DreuceanKevin R Donahue
Nov 15, 2021·Journal of Clinical Pharmacology·Kathryn SmithAurora Quaye

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Methods Mentioned

BETA
Sedation

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