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Variability in opioid conversion calculators in critically ill children transitioned from fentanyl to hydromorphone
Madison Casten1, Jamie L Miller1, Stephen B Neely1
1University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA.
Insights
Opioid conversion calculators (OCCs) show significant variability when converting fentanyl to hydromorphone in critically ill children. Clinicians should exercise caution due to these inconsistent opioid conversion results.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Pain Management
Background:
- Opioid conversion calculators (OCCs) are essential tools for medication management.
- Accurate opioid conversion is critical for effective pain management and patient safety, especially in vulnerable pediatric populations.
Purpose of the Study:
- To quantify and describe the variability in opioid conversion calculator (OCC) results.
- To assess the range of hydromorphone infusion rates derived from various OCCs in critically ill children transitioning from fentanyl.
Main Methods:
- A descriptive, retrospective study analyzing data from 28 critically ill children (<18 years).
- Seventeen different OCCs were utilized to calculate hydromorphone infusion rates from fentanyl.
- Calculated rates were compared against a defined hydromorphone stabilization rate from prior research.
Main Results:
- A wide median hydromorphone rate range (0.06 to 0.12 mg/kg/h) was observed across the 17 OCCs.
- Certain OCC groups (3 and 6) frequently overestimated the required hydromorphone dose, while others (4 and 5) underestimated it.
- Significant discrepancies between calculated and stabilization hydromorphone rates were noted, highlighting substantial variability.
Conclusions:
- Considerable variability exists among different opioid conversion calculators for fentanyl to hydromorphone conversion in pediatric critical care.
- The findings underscore the need for caution and critical evaluation when using OCCs in this patient population.
- Further research may be warranted to standardize OCCs or develop more reliable conversion methods for pediatric patients.
Purpose:
Opioid conversion calculators (OCCs) are used to convert between opioids. The purpose of this study was to describe the variability in OCC results in critically ill children transitioned from fentanyl to hydromorphone infusions.
Methods:
This was a descriptive, retrospective study. Seventeen OCCs were identified and grouped into 6 groups (groups 1-6) based on the equianalgesic conversions. The OCCs were used to calculate the hydromorphone rate in critically ill children (<18 years) converted from fentanyl to hydromorphone. Information from a previous study on children stabilized on hydromorphone (defined as the first 24-hour period with no change in the hydromorphone rates, <3 hydromorphone boluses administered, and 80% of State Behavior Scale scores between 0 and -1) were utilized. The primary objective was to compare the median hydromorphone rates calculated using the 17 OCCs. The secondary objective was to compare the percent variability of the OCC-calculated hydromorphone rates to the stabilization rate.
Results:
Seventeen OCCs were applied to data on 28 children with a median age and hydromorphone rate of 2.4 years and 0.08 mg/kg/h, respectively. The median hydromorphone rate calculated using the 17 OCCs ranged from 0.06 to 0.12 mg/kg/h. Group 3 and group 6 OCCs resulted in a calculated hydromorphone rate that was higher than the stabilization rate in 96% and 75% of patients, respectively. Use of group 4 and group 5 OCCs resulted in a calculated hydromorphone rate that was lower than the stabilization rate in 64% and 75% of patients, respectively.
Conclusion:
Given the considerable variability of OCCs, caution should be used when applying OCCs to critically ill children.
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