ArticlePediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies2013
Opioid analgesia in mechanically ventilated children: results from the multicenter Measuring Opioid Tolerance Induced by Fentanyl study.
Article in Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 2 of them syntheses that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
33 citing papers in PubMed, 2 syntheses or guidelines pooled it, 82 citations in OpenAlex.
- Opioids for newborn infants receiving mechanical ventilation.The Cochrane database of systematic reviews · 2021Pooled it
- Risk factors associated with iatrogenic opioid and benzodiazepine withdrawal in critically ill pediatric patients: a systematic review and conceptual model.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2015Pooled it
- Sedation Management for Critically Ill Children with Pre-Existing Cognitive Impairment.The Journal of pediatrics · 2019Trial
- Efficacy and Safety of Fentanyl in Combination with Midazolam in Children on Mechanical Ventilation.Journal of Korean medical science · 2019Trial
- Patterns of Sedation Weaning in Critically Ill Children Recovering From Acute Respiratory Failure.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2016Trial
- Protocolized vs. Conventional Sedation Among Mechanically Ventilated Children in a Pediatric Intensive Care Unit - A Pre-Post Study.Indian journal of pediatrics · 2026Article
- The Association of Iatrogenic Withdrawal With Opioid and Benzodiazepine Weaning in Children With Bronchiolitis: A Single-Center, Retrospective Cohort Study, 2012-2022.Critical care explorations · 2026Article
- Non-fatal drug overdose among persons who inject drugs during first two years of the COVID-19 pandemic in New York City: Prevalence, risk factors.Drug and alcohol dependence reports · 2023Article
- Propofol Sedation Washouts in Critically Ill Infants: A Case Series.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2023Article
- Adequacy of sedation analgesia to support the comfort of neonates undergoing therapeutic hypothermia and its impact on short-term neonatal outcomes.Frontiers in pediatrics · 2023Article
- The nonopioid cholinergic agonist GTS-21 mitigates morphine-induced aggravation of burn injury pain together with inhibition of spinal microglia activation in young rats.British journal of anaesthesia · 2022Article
- Hypnosis and Sedation for Anxious Children Undergoing Dental Treatment: A Retrospective Practice-Based Longitudinal Study.Children (Basel, Switzerland) · 2022Article
- "Difficult to Sedate": Successful Implementation of a Benzodiazepine-Sparing Analgosedation-Protocol in Mechanically Ventilated Children.Children (Basel, Switzerland) · 2021Article
- Current State of Analgesia and Sedation in the Pediatric Intensive Care Unit.Journal of clinical medicine · 2021Review
- Music Use for Sedation in Critically ill Children (MUSiCC trial): a pilot randomized controlled trial.Journal of intensive care · 2021Article
- Sedation, Analgesia, and Neuromuscular Blockade: An Assessment of Practices From 2009 to 2016 in a National Sample of 66,443 Pediatric Patients Cared for in the ICU.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2020Article
- Opioid use is Associated with ICU Delirium in Mechanically Ventilated Children.Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) · 2020Article
- Music Use for Sedation in Critically ill Children (MUSiCC trial): study protocol for a pilot randomized controlled trial.Pilot and feasibility studies · 2020Article
- Opioid and benzodiazepine use during therapeutic hypothermia in encephalopathic neonates.Journal of perinatology : official journal of the California Perinatal Association · 2020Article
- Malignant cerebellar edema in three-year-old girl following accidental opioid ingestion and fentanyl administration.The neuroradiology journal · 2019Article
Corrections and comments
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Authors and funding
15 authors at 10 institutions in 1 country.
Funding
Abstract
objectiveTo examine the clinical factors associated with increased opioid dose among mechanically ventilated children in the pediatric intensive care unit.
designProspective, observational study with 100% accrual of eligible patients.
settingSeven pediatric intensive care units from tertiary-care children's hospitals in the Collaborative Pediatric Critical Care Research Network. PATIENTS: Four hundred nineteen children treated with morphine or fentanyl infusions.
interventionsNone. MEASUREMENTS AND MAIN
resultsData on opioid use, concomitant therapy, demographic and explanatory variables were collected. Significant variability occurred in clinical practices, with up to 100-fold differences in baseline opioid doses, average daily or total doses, or peak infusion rates. Opioid exposure for 7 or 14 days required doubling of the daily opioid dose in 16% patients (95% confidence interval 12%-19%) and 20% patients (95% confidence interval 16%-24%), respectively. Among patients receiving opioids for longer than 3 days (n = 225), this occurred in 28% (95% confidence interval 22%-33%) and 35% (95% confidence interval 29%-41%) by 7 or 14 days, respectively. Doubling of the opioid dose was more likely to occur following opioid infusions for 7 days or longer (odds ratio 7.9, 95% confidence interval 4.3-14.3; p < 0.001) or co-therapy with midazolam (odds ratio 5.6, 95% confidence interval 2.4-12.9; p < 0.001), and it was less likely to occur if morphine was used as the primary opioid (vs. fentanyl) (odds ratio 0.48, 95% confidence interval 0.25-0.92; p = 0.03), for patients receiving higher initial doses (odds ratio 0.96, 95% confidence interval 0.95-0.98; p < 0.001), or if patients had prior pediatric intensive care unit admissions (odds ratio 0.37, 95% confidence interval 0.15-0.89; p = 0.03).
conclusionsMechanically ventilated children require increasing opioid doses, often associated with prolonged opioid exposure or the need for additional sedation. Efforts to reduce prolonged opioid exposure and clinical practice variation may prevent the complications of opioid therapy.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.