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

L Nelson Sanchez-Pinto1, Lara P Nelson2, Phuong Lieu3

  • 1Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 73, Chicago, IL 60611-2605, USA.

Journal of Critical Care
|September 18, 2017
PubMed

Insights

A new risk-stratified opioid weaning protocol for critically ill children reduced opioid exposure duration without increasing withdrawal. This approach safely shortens opioid use in pediatric intensive care units.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology
  • Clinical Protocol Implementation

Background:

  • Opioid use is essential for critically ill children but linked to adverse effects like delirium and dependence.
  • Effective strategies are needed to minimize opioid-related complications in pediatric intensive care units (PICUs).

Purpose of the Study:

  • To implement and evaluate a risk-stratified opioid weaning protocol in a pediatric ICU.
  • To reduce the duration of opioid administration in critically ill children.
  • To assess the protocol's impact on opioid withdrawal incidence.

Main Methods:

  • A prospective, pre- and post-intervention study design was employed in a large children's hospital PICU.
  • The study included 107 critically ill children receiving scheduled opioids for ≥7 days.
  • Key outcomes measured were the duration of opioid use and hospital length of stay (LOS).

Main Results:

  • The post-intervention group showed a significantly shorter duration of opioid exposure (17 vs. 22.5 days, p=0.01) and opioid wean (12 vs. 18 days, p=0.01).
  • No significant increase in opioid withdrawal incidence was observed despite reduced opioid duration.
  • Hospital length of stay did not differ significantly between the pre- and post-intervention groups (29 vs. 33 days, p=0.06).

Conclusions:

  • Implementation of a risk-stratified opioid weaning protocol effectively reduced opioid exposure in critically ill children.
  • The protocol achieved its goal of shortening opioid duration without increasing withdrawal complications.
  • The protocol did not impact overall hospital length of stay.
Abstract

Keywords:
Clinical protocolCritical careOpioidsPediatricsRisk assessmentWithdrawal syndrome

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