Study: Measuring Opioid Tolerance Induced by Fentanyl (or Other Opioids) (MOTIF)
Study Type: Prospective Observational Study
Study Period: May 2009 – December 2009
To reduce pain, anxiety, or agitation critically ill children routinely receive opioids for analgesia and sedation in the pediatric intensive care unit (PICU). Routine use of opioid therapy often leads to tolerance and dependence. The objective of this prospective, observational study was to examine the clinical factors associated with increased opioid dose among mechanically ventilated children in the PICU. This study was carried out in seven pediatric intensive care units from tertiary‐care children’s hospitals in the Collaborative Pediatric Critical Care Research Network. Five hundred children receiving intravenous opioids in the PICU between May 2009 and October 2009 were enrolled in this study. Data on opioid use, concomitant therapy, demographic and explanatory variables were collected for the duration of opioid therapy, or 14 days after enrollment, until PICU discharge or the patient’s death. Conclusions from this study indicate that mechanically ventilated children require increasing opioid doses, often associated with prolonged opioid exposure or the need for additional sedation. Efforts to avoid prolonged opioid exposure and reduce clinical practice variation may prevent the complications of opioid therapy.