Pharmacokinetics of continuous infusions of fentanyl in critically ill children.

Abstract:

OBJECTIVE:To determine the pharmacokinetics of fentanyl when used as a long-term continuous infusion for sedation/analgesia in mechanically ventilated critically ill infants and children. DESIGN:Prospective, case series. SETTING:A university hospital pediatric intensive care unit (ICU). PATIENTS:Nineteen mechanically ventilated infants and children (0.05 to 14 yrs of age) who received continuous infusions of fentanyl for > 24 hrs. INTERVENTIONS:None. MEASUREMENTS:Plasma concentrations of fentanyl were measured 1 hr after a loading dose and at various intervals during and after the infusions were discontinued. Noncompartmental pharmacokinetic variables, total body clearance, volume of distribution at steady state, and terminal elimination half-life were calculated. Clinical sedation scores, ventilatory settings, pupillary size and reactivity, and patient demographics were recorded. RESULTS:After the use of fentanyl by long-term infusion, the volume of distribution at steady state was increased 15.2 L/kg (range 5.1 to 30.5) and the terminal elimination half-life was prolonged 21.1 hrs (range 11.2 to 36.0) compared with previous studies. Clearance was rapid and consistent with other studies. There was a large interpatient variability in clearance that was age dependent. Clearance did not appear to increase over time. CONCLUSIONS:Total body clearance of fentanyl is highly variable and it should be dosed to effect. Patients seen in a pediatric ICU may require a ten-fold variability in fentanyl infusion rates to achieve similar levels of sedation.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Katz R,Kelly HW

doi

10.1097/00003246-199307000-00012

subject

Has Abstract

pub_date

1993-07-01 00:00:00

pages

995-1000

issue

7

eissn

0090-3493

issn

1530-0293

journal_volume

21

pub_type

杂志文章
  • Sleep and Work in ICU Physicians During a Randomized Trial of Nighttime Intensivist Staffing.

    abstract:OBJECTIVES:To compare sleep, work hours, and behavioral alertness in faculty and fellows during a randomized trial of nighttime in-hospital intensivist staffing compared with a standard daytime intensivist model. DESIGN:Prospective observational study. SETTING:Medical ICU of a tertiary care academic medical center du...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000003773

    authors: Bakhru RN,Basner M,Kerlin MP,Halpern SD,Hansen-Flaschen J,Rosen IM,Dinges DF,Schweickert WD

    更新日期:2019-07-01 00:00:00

  • N-acetylcysteine is effective for prevention but not for treatment of folic acid-induced acute kidney injury in mice.

    abstract:OBJECTIVES:There is controversy regarding the benefits of N-acetylcysteine in acute kidney injury. This study was to compare three commonly used regimens and explore which regimen is best for the protection of acute kidney injury. DESIGN:Prospective experimental study. SETTING:University research laboratory. INTERVE...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e31822575fc

    authors: Wang HZ,Peng ZY,Wen XY,Rimmelé T,Bishop JV,Kellum JA

    更新日期:2011-11-01 00:00:00

  • Instrumentation for the continuous measurement of gas exchange and ventilation of infants during assisted ventilation.

    abstract::A system of instrumentation for continuous measurement of oxygen consumption (VO2), carbon dioxide production (VCO2) and minute ventilation (V1) in human newborns on assisted ventilation is described. VO2 and VCO2 are measured by open-circuit indirect calorimetry utilizing a Servomex OA 184 differential paramagnetic o...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198311000-00011

    authors: Schulze K,Stefanski M,Masterson J,James LS

    更新日期:1983-11-01 00:00:00

  • The Period 2 Enhancer Nobiletin as Novel Therapy in Murine Models of Circadian Disruption Resembling Delirium.

    abstract:OBJECTIVES:Delirium occurs in approximately 30% of critically ill patients, and the risk of dying during admission doubles in those patients. Molecular mechanisms causing delirium are largely unknown. However, critical illness and the ICU environment consistently disrupt circadian rhythms, and circadian disruptions are...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000003077

    authors: Gile J,Scott B,Eckle T

    更新日期:2018-06-01 00:00:00

  • Accurate and precise delivery of nitric oxide during high-frequency oscillatory ventilation.

    abstract:BACKGROUND:We have previously described a method for the precise delivery of inhaled nitric oxide (iNO) via a conventional, continuous-flow, pressure-limited, time-cycled ventilator. Because of the augmented effect of iNO decreasing pulmonary vascular resistance with high-frequency oscillatory ventilation (HFOV), we de...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199911000-00038

    authors: Espinosa RM,Marks KH

    更新日期:1999-11-01 00:00:00

  • Impact of adherence to standard operating procedures for pneumonia on outcome of intensive care unit patients.

    abstract:BACKGROUND:Pneumonia accounts for almost half of intensive care unit (ICU) infections and nearly 60% of deaths from nosocomial infections. It increases hospital stay by 7-9 days, crude mortality by 70% and attributable mortality by 30%. OBJECTIVE:Our purpose was to assess the impact of standard operating procedures ad...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3181934f1b

    authors: Nachtigall I,Tamarkin A,Tafelski S,Deja M,Halle E,Gastmeier P,Wernecke KD,Bauer T,Kastrup M,Spies C

    更新日期:2009-01-01 00:00:00

  • Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery--a randomized controlled trial.

    abstract:OBJECTIVE:Cardiac surgery is frequently followed by postoperative delirium, which is associated with increased 1-year mortality, late cognitive deficits, and higher costs. Currently, there are no recommendations for pharmacologic prevention of postoperative delirium. Impaired cholinergic transmission is believed to pla...

    journal_title:Critical care medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/CCM.0b013e31819da780

    authors: Gamberini M,Bolliger D,Lurati Buse GA,Burkhart CS,Grapow M,Gagneux A,Filipovic M,Seeberger MD,Pargger H,Siegemund M,Carrel T,Seiler WO,Berres M,Strebel SP,Monsch AU,Steiner LA

    更新日期:2009-05-01 00:00:00

  • Brief inhalation of low-dose carbon monoxide protects rodents and swine from postoperative ileus.

    abstract:OBJECTIVE:Carbon monoxide (CO), an endogenous byproduct of heme metabolism, is produced at high levels in injured tissue via induction of heme-oxygenase-1 activity, where it contributes to the modulation of proinflammatory processes. Alone, CO has potent anti-inflammatory effects in models of acute and chronic inflamma...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.ccm.0000166349.76514.40

    authors: Moore BA,Overhaus M,Whitcomb J,Ifedigbo E,Choi AM,Otterbein LE,Bauer AJ

    更新日期:2005-06-01 00:00:00

  • Determinants of tidal volume during high-frequency oscillation.

    abstract:OBJECTIVE:High-frequency oscillation has been proposed for use in adult acute respiratory distress syndrome. However, limited data are available on the effect of pressure amplitude and rate (Hz) on tidal volumes delivered during high-frequency oscillation in adults. DESIGN:Prospective, animal model, lung injury study....

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200301000-00035

    authors: Sedeek KA,Takeuchi M,Suchodolski K,Kacmarek RM

    更新日期:2003-01-01 00:00:00

  • Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing.

    abstract:OBJECTIVES:The aim of this study was to evaluate the relative frequency of pediatric in-hospital cardiopulmonary resuscitation events occurring in ICUs compared to general wards. We hypothesized that the proportion of pediatric cardiopulmonary resuscitation provided in ICUs versus general wards has increased over the p...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e31828cf0c0

    authors: Berg RA,Sutton RM,Holubkov R,Nicholson CE,Dean JM,Harrison R,Heidemann S,Meert K,Newth C,Moler F,Pollack M,Dalton H,Doctor A,Wessel D,Berger J,Shanley T,Carcillo J,Nadkarni VM,Eunice Kennedy Shriver National Institute

    更新日期:2013-10-01 00:00:00

  • Mechanical influences on the capnogram.

    abstract::We found that altering aspirating flow rate (ASR) and sample tubing length (STL) affected the response time and capnogram of 2 different side-stream capnometers. Increased flow rate shortened rise time, transit time, and total delay time (TDT), whereas increased STL increased transit and TDTs but not rise time. Increa...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198408000-00015

    authors: Schena J,Thompson J,Crone RK

    更新日期:1984-08-01 00:00:00

  • Long-Term Mental Health Problems After Delirium in the ICU.

    abstract:OBJECTIVES:To determine whether delirium during ICU stay is associated with long-term mental health problems defined as symptoms of anxiety, depression, and posttraumatic stress disorder. DESIGN:Prospective cohort study. SETTING:Survey study, 1 year after discharge from a medical-surgical ICU in the Netherlands. PAT...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000001861

    authors: Wolters AE,Peelen LM,Welling MC,Kok L,de Lange DW,Cremer OL,van Dijk D,Slooter AJ,Veldhuijzen DS

    更新日期:2016-10-01 00:00:00

  • Liquid lung ventilation reduces neutrophil sequestration in a neonatal swine model of cardiopulmonary bypass.

    abstract:OBJECTIVE:Liquid lung ventilation has been demonstrated to improve cardiorespiratory function after cardiopulmonary bypass. We hypothesized that liquid lung ventilation (LLV) would decrease the pulmonary inflammatory response after cardiopulmonary bypass (CPB). DESIGN:Prospective, randomized, experimental, controlled,...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200104000-00021

    authors: Williams EA,Welty SE,Geske RS,Hubble CL,Craig DM,Quick G,Meliones JN,Cheifetz IM

    更新日期:2001-04-01 00:00:00

  • Hypocalcemia during porcine endotoxemic shock: effects of calcium administration.

    abstract:OBJECTIVE:To evaluate the pathophysiology involved in hypocalcemia in septic shock and to investigate the value of calcium administration. DESIGN:Prospective, randomized placebo-controlled trial with parallel groups. SETTING:Animal research laboratory at the University Hospital of Uppsala. SUBJECTS:Twenty-four pigs ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200008000-00037

    authors: Carlstedt F,Eriksson M,Kiiski R,Larsson A,Lind L

    更新日期:2000-08-01 00:00:00

  • Pentoxifylline increases gut ketogenesis following trauma and hemorrhagic shock.

    abstract:OBJECTIVES:Although pentoxifylline produces various beneficial effects following adverse circulatory conditions, it is not known whether this agent has any effects on gut lipid metabolism after trauma-hemorrhage and resuscitation. The aim of this study, therefore, was to determine whether or not administration of pento...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199801000-00023

    authors: Wang W,Wang P,Chaudry IH

    更新日期:1998-01-01 00:00:00

  • At-risk drinkers are at higher risk to acquire a bacterial infection during an intensive care unit stay than abstinent or moderate drinkers.

    abstract:OBJECTIVES:To determine whether excessive alcohol consumption increases the risk for intensive care unit (ICU)-acquired bacterial infection, especially ventilator-associated pneumonia (VAP), in nontrauma patients. DESIGN:Prospective observational cohort study. SETTING:A 21-bed polyvalent ICU in a university hospital....

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e318174dd75

    authors: Gacouin A,Legay F,Camus C,Volatron AC,Barbarot N,Donnio PY,Thomas R,Le Tulzo Y

    更新日期:2008-06-01 00:00:00

  • The effects of the rate of postresuscitation rewarming following hypothermia on outcomes of cardiopulmonary resuscitation in a rat model.

    abstract:OBJECTIVE:To investigate the optimal rewarming rate following therapeutic hypothermia in a rate model of cardiopulmonary resuscitation. Both clinical and laboratory studies have demonstrated that mild therapeutic hypothermia following cardiopulmonary resuscitation improves myocardial and neurologic outcomes of cardiac ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3182a63fff

    authors: Lu X,Ma L,Sun S,Xu J,Zhu C,Tang W

    更新日期:2014-02-01 00:00:00

  • Retention of cardiopulmonary resuscitation skills after initial overtraining.

    abstract::The authors have examined cardiopulmonary resuscitation (CPR) skills retention in a police force initially trained to instructor level performance skills as defined by the 1977 American Heart Association Instructor Manual. In 1977, the entire Winnipeg Police Force received a basic 8-h course of CPR training with recor...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198011000-00011

    authors: Tweed WA,Wilson E,Isfeld B

    更新日期:1980-11-01 00:00:00

  • Role of exogenous surfactant in acute lung injury.

    abstract:OBJECTIVES:To outline both the preclinical and clinical data demonstrating surfactant alterations in acute lung injury, which provide the rationale for testing exogenous surfactant administration in this setting. We also review the results of the randomized, controlled clinical trials conducted to date that have evalua...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/01.CCM.0000057911.19145.9F

    authors: Lewis JF,Brackenbury A

    更新日期:2003-04-01 00:00:00

  • Hypercapnic acidosis induced by nutrition in mechanically ventilated patients: glucose versus fat.

    abstract::Total parenteral nutrition (TPN) increases CO2 production (VCO2) in patients on intermittent positive-pressure ventilation who cannot match their CO2 excretion to the CO2 load, leading to an increase in PaCO2. We studied gas exchange and blood gas values in six patients with chronic respiratory failure, who were venti...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198507000-00005

    authors: Herve P,Simonneau G,Girard P,Cerrina J,Mathieu M,Duroux P

    更新日期:1985-07-01 00:00:00

  • Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol.

    abstract:OBJECTIVES:To describe the effectiveness of a comprehensive, interdisciplinary sepsis treatment protocol with regard to both implementation and outcomes and to compare the mortality rates and therapies of patients with septic shock with similar historical controls. DESIGN:Prospective, interventional cohort study with ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.CCM.0000206104.18647.A8

    authors: Shapiro NI,Howell MD,Talmor D,Lahey D,Ngo L,Buras J,Wolfe RE,Weiss JW,Lisbon A

    更新日期:2006-04-01 00:00:00

  • The lectin-like domain of tumor necrosis factor improves lung function after rat lung transplantation--potential role for a reduction in reactive oxygen species generation.

    abstract:OBJECTIVE:To test the hypothesis that the lectin-like domain of tumor necrosis factor, mimicked by the TIP peptide, can improve lung function after unilateral orthotopic lung isotransplantation. Because of a lack of a specific treatment for ischemia reperfusion-mediated lung injury, accompanied by a disrupted barrier i...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3181cdf725

    authors: Hamacher J,Stammberger U,Roux J,Kumar S,Yang G,Xiong C,Schmid RA,Fakin RM,Chakraborty T,Hossain HM,Pittet JF,Wendel A,Black SM,Lucas R

    更新日期:2010-03-01 00:00:00

  • Improving clinical trials of long-term outcomes.

    abstract::There is an increasing evidence that survivors of critical illness suffer from impaired health-related quality of life. There are relatively few studies that have evaluated the effect of interventions in clinical trials to improve these long-term outcomes. Studies to improve long-term outcomes after critical illness f...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3181922bb7

    authors: Rubenfeld GD

    更新日期:2009-01-01 00:00:00

  • Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units.

    abstract:OBJECTIVE:Although the development of ventilator-associated pneumonia (VAP) is assumed to increase costs of intensive care unit stay, it is unknown whether prevention of VAP by means of oropharyngeal decontamination is cost-effective. Because of wide ranges of individual patient costs, crude cost comparisons did not sh...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.CCM.0000104111.61317.4B

    authors: van Nieuwenhoven CA,Buskens E,Bergmans DC,van Tiel FH,Ramsay G,Bonten MJ

    更新日期:2004-01-01 00:00:00

  • High permeability dialysis membrane allows effective removal of myoglobin in acute kidney injury resulting from rhabdomyolysis.

    abstract:OBJECTIVE:The objective of this study was to test the ability of myoglobin removal of a novel, high-permeability polysulphone dialyzer in acute kidney injury as a result of rhabdomyolysis. SETTING:Intensive care unit of a tertiary care hospital. PATIENTS:Six patients (one female; aged 24, 36, 41, 55, 63, and 65 yrs) ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3181feb7f0

    authors: Sorrentino SA,Kielstein JT,Lukasz A,Sorrentino JN,Gohrbandt B,Haller H,Schmidt BM

    更新日期:2011-01-01 00:00:00

  • Written information that relatives of adult intensive care unit patients would like to receive--a comparison to published recommendations and opinion of staff members.

    abstract:OBJECTIVE:Information booklets have not been assessed by the families of intensive care unit (ICU) patients. This study explored the information that the relatives of adult ICU patients wanted to find in the information booklets. DESIGN:Multicenter survey. SETTING:Twenty-three French ICUs. SUBJECTS:One close relativ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1097/CCM.0b013e3181a03063

    authors: Soltner C,Lassalle V,Galienne-Bouygues S,Pottecher J,Floccard B,Delapierre L,Jungfer F,Sargentini C,Alberti C,Beydon L,Lifrea Group.

    更新日期:2009-07-01 00:00:00

  • Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference.

    abstract:BACKGROUND:Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge. OBJECTIVES:To report on a 2-day Society of Critical Car...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/CCM.0b013e318232da75

    authors: Needham DM,Davidson J,Cohen H,Hopkins RO,Weinert C,Wunsch H,Zawistowski C,Bemis-Dougherty A,Berney SC,Bienvenu OJ,Brady SL,Brodsky MB,Denehy L,Elliott D,Flatley C,Harabin AL,Jones C,Louis D,Meltzer W,Muldoon SR,Pa

    更新日期:2012-02-01 00:00:00

  • Intravenous insulin nomogram improves blood glucose control in the critically ill.

    abstract:OBJECTIVE:To improve control of blood glucose concentrations in critically ill patients through use of a bedside, nurse-managed, intravenous insulin nomogram. DESIGN:Retrospective, before-after cohort study. SETTING:Fifteen-bed mixed medical/surgical intensive care unit in a tertiary, teaching hospital. PATIENTS:A t...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200109000-00010

    authors: Brown G,Dodek P

    更新日期:2001-09-01 00:00:00

  • Continuous lateral rotation therapy to prevent ventilator-associated pneumonia.

    abstract:OBJECTIVE:To investigate the impact of prophylactic continuous lateral rotation therapy on the prevalence of ventilator-associated pneumonia, duration of mechanical ventilation, length of stay, and mortality in critically ill medical patients. DESIGN:Prospective, randomized, clinical study. SETTING:Three medical inte...

    journal_title:Critical care medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/CCM.0b013e3181bc8218

    authors: Staudinger T,Bojic A,Holzinger U,Meyer B,Rohwer M,Mallner F,Schellongowski P,Robak O,Laczika K,Frass M,Locker GJ

    更新日期:2010-02-01 00:00:00

  • Titration of intravenous anesthetics for cardioversion: a comparison of propofol, methohexital, and midazolam.

    abstract:OBJECTIVE:To compare propofol, methohexital, and midazolam administered as titrated infusions for sedation during electrical cardioversion. DESIGN:A prospective, randomized, single-blind comparative study. SETTING:Coronary care unit in a military teaching hospital. PATIENTS:Thirty adult patients with atrial fibrilla...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00003246-199310000-00019

    authors: Gale DW,Grissom TE,Mirenda JV

    更新日期:1993-10-01 00:00:00