The effect of age on clinical dose equivalency of fentanyl and morphine analgosedation in mechanically ventilated patients: Findings from the ANALGESIC trial.

Adolescent Adult Aged, 80 and over Humans Young Adult Analgesics Analgesics, Opioid Fentanyl Morphine Respiration, Artificial Therapeutic Equivalency Randomized Controlled Trials as Topic Cross-Over Studies
Analgosedation Dose equivalency Fentanyl Mechanical ventilation Morphine

Journal

Australian critical care : official journal of the Confederation of Australian Critical Care Nurses
ISSN: 1036-7314
Titre abrégé: Aust Crit Care
Pays: Australia
ID NLM: 9207852

Informations de publication

Date de publication:
Mar 2024
Historique:
received: 06 02 2023
revised: 18 06 2023
accepted: 06 07 2023
medline: 12 3 2024
pubmed: 14 8 2023
entrez: 13 8 2023
Statut: ppublish

Résumé

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. 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. 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. 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). 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.

Sections du résumé

BACKGROUND 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 OBJECTIVE
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 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 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 CONCLUSIONS
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.

Identifiants

DOI: 10.1016/j.aucc.2023.07.001 PMID: 37574387
pubmed: 37574387
pii: S1036-7314(23)00094-2
doi: 10.1016/j.aucc.2023.07.001
pii:
doi:

Substances chimiques

Analgesics 0
Analgesics, Opioid 0
Fentanyl UF599785JZ
Morphine 76I7G6D29C

Types de publication

Journal Article

Langues

eng

Pagination

236-243

Informations de copyright

Copyright © 2023 Australian College of Critical Care Nurses Ltd. All rights reserved.

Auteurs

Andrew Casamento (A)

Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Intensive Care, Northern Hospital, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia. Electronic address: Andrew.casamento@austin.org.au.

Angajendra Ghosh (A)

Department of Intensive Care, Northern Hospital, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Department of Medical Education, University of Melbourne, Melbourne, Australia.

Ary Serpa Neto (AS)

Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Data Analytics Research & Evaluation (DARE) Center, University of Melbourne and Austin Hospital, Melbourne, Australia; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.

Marcus Young (M)

Department of Critical Care, University of Melbourne, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

Mervin Lawrence (M)

Department of Intensive Care, Northern Hospital, Melbourne, Australia.

Christina Taplin (C)

Department of Intensive Care, Northern Hospital, Melbourne, Australia.

Glenn M Eastwood (GM)

Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia.

Rinaldo Bellomo (R)

Department of Intensive Care, Austin Hospital, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Data Analytics Research & Evaluation (DARE) Center, University of Melbourne and Austin Hospital, Melbourne, Australia.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adolescent › The effect of age on clinical dose equivalency...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › The effect of age on clinical dose equivalency...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › The effect of age on clinical dose equivalency...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The effect of age on clinical dose equivalency...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Jeune adulte › The effect of age on clinical dose equivalency...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents du système nerveux central › Analgésiques › The effect of age on clinical dose equivalency...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents du système nerveux central › Dépresseurs du système nerveux central › Stupéfiants › Analgésiques morphiniques › The effect of age on clinical dose equivalency...
questionsmedicales.fr › Composés hétérocycliques › Composés hétéromonocycliques › Pipéridines › Fentanyl › The effect of age on clinical dose equivalency...
questionsmedicales.fr › Composés polycycliques › Hydrocarbures aromatiques polycycliques › Phénanthrènes › Morphinanes › Dérivés de la morphine › Morphine › The effect of age on clinical dose equivalency...
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Ventilation artificielle › The effect of age on clinical dose equivalency...
questionsmedicales.fr › Phénomènes physiologiques › Phénomènes pharmacologiques et toxicologiques › Pharmacocinétique › Équivalence thérapeutique › The effect of age on clinical dose equivalency...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Essais cliniques comme sujet › Essais cliniques contrôlés comme sujet › Essais contrôlés randomisés comme sujet › The effect of age on clinical dose equivalency...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Méthodologie en recherche épidémiologique › Études croisées › The effect of age on clinical dose equivalency...