Replacement of fentanyl infusion by enteral methadone decreases the weaning time from mechanical ventilation: a randomized controlled trial

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorWANZUITA, Raquel
dc.contributor.authorPOLI-DE-FIGUEIREDO, Luiz F.
dc.contributor.authorPFUETZENREITER, Felipe
dc.contributor.authorCAVALCANTI, Alexandre Biasi
dc.contributor.authorWESTPHAL, Glauco Adrieno
dc.date.accessioned2013-07-30T14:39:08Z
dc.date.available2013-07-30T14:39:08Z
dc.date.issued2012
dc.description.abstractIntroduction: Patients undergoing mechanical ventilation (MV) are frequently administered prolonged and/or high doses of opioids which when removed can cause a withdrawal syndrome and difficulty in weaning from MV. We tested the hypothesis that the introduction of enteral methadone during weaning from sedation and analgesia in critically ill adult patients on MV would decrease the weaning time from MV. Methods: A double-blind randomized controlled trial was conducted in the adult intensive care units (ICUs) of four general hospitals in Brazil. The 75 patients, who met the criteria for weaning from MV and had been using fentanyl for more than five consecutive days, were randomized to the methadone (MG) or control group (CG). Within the first 24 hours after study enrollment, both groups received 80% of the original dose of fentanyl, the MG received enteral methadone and the CG received an enteral placebo. After the first 24 hours, the MG received an intravenous (IV) saline solution (placebo), while the CG received IV fentanyl. For both groups, the IV solution was reduced by 20% every 24 hours. The groups were compared by evaluating the MV weaning time and the duration of MV, as well as the ICU stay and the hospital stay. Results: Of the 75 patients randomized, seven were excluded and 68 were analyzed: 37 from the MG and 31 from the CG. There was a higher probability of early extubation in the MG, but the difference was not significant (hazard ratio: 1.52 (95% confidence interval (CI) 0.87 to 2.64; P = 0.11). The probability of successful weaning by the fifth day was significantly higher in the MG (hazard ratio: 2.64 (95% CI: 1.22 to 5.69; P < 0.02). Among the 54 patients who were successfully weaned (29 from the MG and 25 from the CG), the MV weaning time was significantly lower in the MG (hazard ratio: 2.06; 95% CI 1.17 to 3.63; P < 0.004). Conclusions: The introduction of enteral methadone during weaning from sedation and analgesia in mechanically ventilated patients resulted in a decrease in the weaning time from MV.
dc.description.indexMEDLINE
dc.identifier.citationCRITICAL CARE, v.16, n.2, article ID R49, 9p, 2012
dc.identifier.doi10.1186/cc11250
dc.identifier.issn1466-609X
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/364
dc.language.isoeng
dc.publisherBIOMED CENTRAL LTD
dc.relation.ispartofCritical Care
dc.rightsrestrictedAccess
dc.rights.holderCopyright BIOMED CENTRAL LTD
dc.subject.otherintensive-care-unit
dc.subject.othercritically-ill patients
dc.subject.otheropioid abstinence syndrome
dc.subject.othermedical-treatment
dc.subject.othersedation
dc.subject.otheranalgesia
dc.subject.otherduration
dc.subject.otherprotocol
dc.subject.otheradult
dc.subject.otherremifentanil
dc.subject.wosCritical Care Medicine
dc.titleReplacement of fentanyl infusion by enteral methadone decreases the weaning time from mechanical ventilation: a randomized controlled trial
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.author.externalWANZUITA, Raquel:Ctr Hosp Unimed, Adult ICU, BR-89204060 Joinville, Brazil; Hosp Reg Hans Dieter Schmidt, Adult ICU, BR-89227680 Joinville, Brazil
hcfmusp.author.externalPFUETZENREITER, Felipe:Ctr Hosp Unimed, Adult ICU, BR-89204060 Joinville, Brazil; Hosp Municipal Sao Jose, Adult ICU, BR-89202000 Joinville, Brazil
hcfmusp.author.externalCAVALCANTI, Alexandre Biasi:Hosp Coracao, Res Inst, BR-04005000 Sao Paulo, Brazil
hcfmusp.author.externalWESTPHAL, Glauco Adrieno:Ctr Hosp Unimed, Adult ICU, BR-89204060 Joinville, Brazil; Hosp Municipal Sao Jose, Adult ICU, BR-89202000 Joinville, Brazil
hcfmusp.citation.scopus37
hcfmusp.contributor.author-fmusphcLUIZ FRANCISCO POLI DE FIGUEIREDO
hcfmusp.description.articlenumberR49
hcfmusp.description.issue2
hcfmusp.description.volume16
hcfmusp.origemWOS
hcfmusp.origem.pubmed22420584
hcfmusp.origem.scopus2-s2.0-84858131476
hcfmusp.origem.wosWOS:000313196800015
hcfmusp.publisher.cityLONDON
hcfmusp.publisher.countryENGLAND
hcfmusp.relation.referenceAmato L., 2005, COCHRANE DB SYST REV, DOI 10.1002/14651858.CD004147.
hcfmusp.relation.referenceANAND KJS, 1994, CRIT CARE MED, V22, P334, DOI 10.1097/00003246-199402000-00027
hcfmusp.relation.referenceARNOLD JH, 1990, ANESTHESIOLOGY, V73, P1136, DOI 10.1097/00000542-199012000-00011
hcfmusp.relation.referenceBreen D, 2005, CRIT CARE, V9, pR200, DOI 10.1186/cc3495
hcfmusp.relation.referenceBrook AD, 1999, CRIT CARE MED, V27, P2609, DOI 10.1097/00003246-199912000-00001
hcfmusp.relation.referenceCammarano WB, 1998, CRIT CARE MED, V26, P676, DOI 10.1097/00003246-199804000-00015
hcfmusp.relation.referenceDOLE VP, 1965, J AMER MED ASSOC, V193, P646
hcfmusp.relation.referenceEpstein J, 1999, CRIT CARE CLIN, V15, P17, DOI 10.1016/S0749-0704(05)70037-3
hcfmusp.relation.referenceESTEBAN A, 1995, NEW ENGL J MED, V332, P345, DOI 10.1056/NEJM199502093320601
hcfmusp.relation.referenceGirard TD, 2008, LANCET, V371, P126, DOI 10.1016/S0140-6736(08)60105-1
hcfmusp.relation.referenceGowing L, 2009, COCHRANE DB SYST REV, DOI 10.1002/14651858.CD002025.pub4
hcfmusp.relation.referenceGowing L, 2009, COCHRANE DB SYST REV, DOI 10.1002/14651858.CD002024.pub3
hcfmusp.relation.referenceHoney BL, 2009, ANN PHARMACOTHER, V43, P1506, DOI 10.1345/aph.1M161
hcfmusp.relation.referenceJacobi J, 2002, CRIT CARE MED, V30, P119, DOI 10.1097/00003246-200201000-00020
hcfmusp.relation.referenceKATZ R, 1994, CRIT CARE MED, V22, P763, DOI 10.1097/00003246-199405000-00009
hcfmusp.relation.referenceKNAUS WA, 1985, CRIT CARE MED, V13, P818, DOI 10.1097/00003246-198510000-00009
hcfmusp.relation.referenceKollef MH, 1998, CHEST, V114, P541, DOI 10.1378/chest.114.2.541
hcfmusp.relation.referenceKress JP, 2000, NEW ENGL J MED, V342, P1471, DOI 10.1056/NEJM200005183422002
hcfmusp.relation.referenceLugo RA, 2001, PHARMACOTHERAPY, V21, P1566, DOI 10.1592/phco.21.20.1566.34471
hcfmusp.relation.referenceMacIntyre NR, 2001, CHEST, V120, P375, DOI 10.1378/CHEST.120.6_
hcfmusp.relation.referenceMeyer M M, 2001, Pediatr Crit Care Med, V2, P329, DOI 10.1097/00130478-200110000-00009
hcfmusp.relation.referenceNational consensus development panel on effective medical treatment of opiate addiction, 1998, JAMA, V280, P1936
hcfmusp.relation.referenceNovaes MAFP, 1999, INTENS CARE MED, V25, P1421, DOI 10.1007/s001340051091
hcfmusp.relation.referenceNseir S, 2010, CRIT CARE, V14, DOI 10.1186/cc8907
hcfmusp.relation.referencePayen JF, 2007, ANESTHESIOLOGY, V106, P687, DOI 10.1097/01.anes.0000264747.09017.da
hcfmusp.relation.referencePUNTILLO KA, 1990, HEART LUNG, V19, P526
hcfmusp.relation.referenceRobertson R C, 2000, Pediatr Crit Care Med, V1, P119, DOI 10.1097/00130478-200010000-00005
hcfmusp.relation.referenceRozendaal F, 2009, INTENS CARE MED, V35, P291, DOI 10.1007/s00134-008-1328-9
hcfmusp.relation.referenceSalluh JIF, 2009, J CRIT CARE, V24, P556, DOI 10.1016/j.jcrc.2009.04.004
hcfmusp.relation.referenceSHAPIRO BA, 1995, CRIT CARE MED, V23, P1596, DOI 10.1097/00003246-199509000-00021
hcfmusp.relation.referenceStrom T, 2010, LANCET, V375, P475, DOI 10.1016/S0140-6736(09)62072-9
hcfmusp.relation.referenceTOBIAS JD, 1994, INTENS CARE MED, V20, P504, DOI 10.1007/BF01711905
hcfmusp.relation.referenceTOBIAS JD, 1990, CRIT CARE MED, V18, P1292, DOI 10.1097/00003246-199011000-00024
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