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

L. Nelson Sanchez-Pinto, Lara P. Nelson, Phuong Lieu, Joyce Y. Koh, John W. Rodgers, Krichelle A. Larson, Jennifer M. Huson, Rambod Amirnovin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)214-219
Number of pages6
JournalJournal of Critical Care
Volume43
DOIs
StatePublished - Feb 1 2018

Keywords

  • Clinical protocol
  • Critical care
  • Opioids
  • Pediatrics
  • Risk assessment
  • Withdrawal syndrome

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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