The effect of age on clinical dose equivalency of fentanyl and morphine analgosedation in mechanically ventilated patients : Findings from the ANALGESIC trial
Copyright © 2023 Australian College of Critical Care Nurses Ltd. All rights reserved..
BACKGROUND: The dose equivalency of fentanyl vs. morphine is widely considered to be approximately 1:100. However, little is known about the effect of age on this ratio when these agents are used as infusions for analgosedation.
OBJECTIVES: To assess the impact of age on the clinical dose equivalency of fentanyl and morphine when used as infusions for analgosedation in mechanically ventilated intensive care unit patients.
METHODS: We performed a post hoc analysis of the Assessment of Opioid Administration to Lead to Analgesic Effects and Sedation in Intensive Care (ANALGESIC) cluster randomised crossover trial of fentanyl and morphine infusions for analgosedation. Dose and analgosedative clinical equivalency of fentanyl and morphine were assessed by age and by using different body-size descriptors.
RESULTS: We studied 663 patients (338 fentanyl, 325 morphine). Median (interquartile range) hourly dose of fentanyl and morphine were 58.1 (40.0-89.2) mcg and 3400 (2200-5000) mcg, respectively. The ratio of total dose of fentanyl:morphine was 1:93 in the 18- to 29-year-old group and 1:25 in the ≥80-year-old group (p = 0.015), respectively, with fentanyl becoming relatively less clinically effective as age increased. This effect was also seen when comparing dosing by different body-size descriptors with the strongest age-related change when using body surface area as body-size descriptor (p = 0.009).
CONCLUSION: The analgosedative clinical dose equivalency of fentanyl vs. morphine is heterogeneous when used as infusions for analgosedation, with fentanyl becoming relatively less clinically effective as age increases. This information can help guide prescription of these agents during transition from one agent to the other in critically ill patients.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:37 |
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| Enthalten in: |
Australian critical care : official journal of the Confederation of Australian Critical Care Nurses - 37(2024), 2 vom: 15. März, Seite 236-243 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Casamento, Andrew [VerfasserIn] |
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| Links: |
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| Themen: |
76I7G6D29C |
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| Anmerkungen: |
Date Completed 12.03.2024 Date Revised 20.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.aucc.2023.07.001 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM360738745 |
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| 100 | 1 | |a Casamento, Andrew |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The effect of age on clinical dose equivalency of fentanyl and morphine analgosedation in mechanically ventilated patients |b Findings from the ANALGESIC trial |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 20.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Australian College of Critical Care Nurses Ltd. All rights reserved. | ||
| 520 | |a BACKGROUND: The dose equivalency of fentanyl vs. morphine is widely considered to be approximately 1:100. However, little is known about the effect of age on this ratio when these agents are used as infusions for analgosedation | ||
| 520 | |a OBJECTIVES: To assess the impact of age on the clinical dose equivalency of fentanyl and morphine when used as infusions for analgosedation in mechanically ventilated intensive care unit patients | ||
| 520 | |a METHODS: We performed a post hoc analysis of the Assessment of Opioid Administration to Lead to Analgesic Effects and Sedation in Intensive Care (ANALGESIC) cluster randomised crossover trial of fentanyl and morphine infusions for analgosedation. Dose and analgosedative clinical equivalency of fentanyl and morphine were assessed by age and by using different body-size descriptors | ||
| 520 | |a RESULTS: We studied 663 patients (338 fentanyl, 325 morphine). Median (interquartile range) hourly dose of fentanyl and morphine were 58.1 (40.0-89.2) mcg and 3400 (2200-5000) mcg, respectively. The ratio of total dose of fentanyl:morphine was 1:93 in the 18- to 29-year-old group and 1:25 in the ≥80-year-old group (p = 0.015), respectively, with fentanyl becoming relatively less clinically effective as age increased. This effect was also seen when comparing dosing by different body-size descriptors with the strongest age-related change when using body surface area as body-size descriptor (p = 0.009) | ||
| 520 | |a CONCLUSION: The analgosedative clinical dose equivalency of fentanyl vs. morphine is heterogeneous when used as infusions for analgosedation, with fentanyl becoming relatively less clinically effective as age increases. This information can help guide prescription of these agents during transition from one agent to the other in critically ill patients | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Analgosedation | |
| 650 | 4 | |a Dose equivalency | |
| 650 | 4 | |a Fentanyl | |
| 650 | 4 | |a Mechanical ventilation | |
| 650 | 4 | |a Morphine | |
| 650 | 7 | |a Analgesics |2 NLM | |
| 650 | 7 | |a Analgesics, Opioid |2 NLM | |
| 650 | 7 | |a Fentanyl |2 NLM | |
| 650 | 7 | |a UF599785JZ |2 NLM | |
| 650 | 7 | |a Morphine |2 NLM | |
| 650 | 7 | |a 76I7G6D29C |2 NLM | |
| 700 | 1 | |a Ghosh, Angajendra |e verfasserin |4 aut | |
| 700 | 1 | |a Neto, Ary Serpa |e verfasserin |4 aut | |
| 700 | 1 | |a Young, Marcus |e verfasserin |4 aut | |
| 700 | 1 | |a Lawrence, Mervin |e verfasserin |4 aut | |
| 700 | 1 | |a Taplin, Christina |e verfasserin |4 aut | |
| 700 | 1 | |a Eastwood, Glenn M |e verfasserin |4 aut | |
| 700 | 1 | |a Bellomo, Rinaldo |e verfasserin |4 aut | |
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