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Author Spotlight: An Efficient Methodology to Confidently Differentiate and Characterize Fentanyl Analogs
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Characterization of Tolerance in Children during Fentanyl Continuous Infusions.

Bethany W Ibach1, Jamie L Miller2, Sukyung Woo3

  • 1Department of Pharmacy Practice, Texas Tech University Health Sciences Center School of Pharmacy, Abilene, Texas, United States.

Journal of Pediatric Intensive Care
|May 11, 2019
PubMed
Summary

Fentanyl continuous infusions (CINs) in critically ill children frequently lead to tolerance, with 78% developing it, often within 24 hours. Lower initial doses and higher cumulative exposure increase tolerance risk.

Keywords:
childcontinuous infusioncritically illfentanylopioidtolerance

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Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology
  • Pain Management

Background:

  • Fentanyl continuous infusions (CINs) are common in critically ill children.
  • Opioid tolerance is a known complication but its incidence and onset in this population are not well-defined.

Purpose of the Study:

  • To determine the incidence and time of onset of fentanyl tolerance in critically ill children.
  • To identify risk factors associated with the development of tolerance.

Main Methods:

  • Retrospective review of 59 fentanyl CINs in children aged 0-17 years, lasting over 3 days.
  • Tolerance defined as a doubling of the fentanyl CIN dose.
  • Logistic regression analysis to identify factors associated with tolerance development.

Main Results:

  • Tolerance occurred in 78% of CINs (46/59), with a median onset time of 26 hours.
  • Early tolerance (<24 hours) was observed in 45.7% of cases.
  • Higher peak and final CIN doses, and greater cumulative exposure were associated with tolerance.
  • Lower initial fentanyl dose and higher cumulative exposure were independently associated with developing tolerance.

Conclusions:

  • Fentanyl tolerance is highly prevalent in critically ill children receiving continuous infusions.
  • Tolerance can develop rapidly, often within the first 24 hours.
  • Initial dosing strategy and total opioid exposure are key factors influencing tolerance development.