Measuring Opioid Tolerance Induced by Fentanyl (or Other Opioids)

To reduce pain, anxiety, or agitation, critically ill children routinely receive opioids for analgesia and sedation. Routine use of opioid therapy often leads to tolerance and dependence. The objective of this study was to examine the clinical factors associated with increased opioid dose among mechanically ventilated children. This study was carried out in 7 pediatric intensive care units from tertiary care children’s hospitals. 500 children receiving intravenous opioids between 5/09 and 10/09 were enrolled. Data on opioid use, concomitant therapy, demographic, and exploratory variables were collected for the duration of opioid therapy, 14 days after enrollment, and until PICU discharge or 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 opioid therapy complications.