Continuous hydromorphone for pain and sedation in mechanically ventilated infants and children

Pamela D. Reiter, PharmD; Jennifer Ng, PharmD; Emily L. Dobyns, MD

doi:10.5055/jom.2012.0102

Authors

Pamela D. Reiter, PharmD
Jennifer Ng, PharmD
Emily L. Dobyns, MD

DOI:

https://doi.org/10.5055/jom.2012.0102

Keywords:

hydromorphone, pediatric, mechanical ventilation

Abstract

Objective: To describe dosing regimens and efficacy of continuous infusion hydromorphone in mechanically ventilated children.
Design: Retrospective review.
Setting: Tertiary care, pediatric hospital.
Patients: Ninety-two critically ill children (<18 years old).
Main outcome measure(s): Hydromorphone dosing requirements, concomitant pain and sedation therapy, patient-specific pain scores (using Face Legs Activity Cry Consolability [FLACC] pain scale), and possible adverse drug events related to therapy.
Results: Starting dose was 0.024 ± 0.04 mg/kg/h. Maximum dose was 0.05 ± 0.1 mg/kg/h. Duration of therapy was 182 ± 169 hours. Most patients received additional pain and sedation therapy. Most mean daily FLACC scores (66 percent) were below 1. Less than 10 percent of scores were above 3; only 1 score was above 6. Mean FLACC score, when averaged per patient course, was 1.004 ± 0.71. Extracorporeal membrane oxygenation (ECMO) patients had a significantly higher initial and maximum dosing requirement than non-ECMO patients (p = 0.001).
Conclusions: Continuous infusion hydromorphone appears to be an effective adjunctive analgesic in mechanically ventilated children.

Author Biographies

Pamela D. Reiter, PharmD

Clinical Pharmacy Specialist, Pediatric Intensive Care Unit, Department of Pharmacy, Center for Pediatric Medicine, Children’s Hospital Colorado, Aurora, Colorado; Clinical Associate Professor, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

Jennifer Ng, PharmD

Pediatric Pharmacy Practice Resident, Children’s Hospital Colorado, Aurora, Colorado.

Emily L. Dobyns, MD

Medical Director, Pediatric Intensive Care Unit, Children’s Hospital Colorado, Aurora, Colorado; Associate Professor of Pediatrics, Section of Critical Care Medicine, Aurora, Colorado.

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