Opioids for neonates receiving mechanical ventilation: a systematic review and meta-analysis

Bellù, Roberto; Waal, Koert de; Zanini, Rinaldo

doi:10.1136/adc.2008.150318

Cited by 118 publications

(105 citation statements)

References 46 publications

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“…45 Contrary to the results of a 2010 systematic review and meta-analysis 33 that opioid exposure did not have an eff ect on the duration of TV in the neonate, in our study exposure to O-SH-GA was associated with prolonged ventilation in the neonates. Additional multivariable analyses (propensity score matching, stratifi cation, and regression adjustment) and analyses in infants in whom these medications were started early after initiation of TV substantiated this fi nding, consistent with the fi ndings from randomised trials of drugrelated respiratory depression in neonates.…”

Section: Discussioncontrasting

confidence: 99%

Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study

Carbajal

Eriksson

Courtois

et al. 2015

The Lancet Respiratory Medicine

161

133

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Section: Discussioncontrasting

confidence: 99%

Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study

Carbajal

Eriksson

Courtois

et al. 2015

The Lancet Respiratory Medicine

161

133

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“…Infants in NICUs are often on ventilators for weeks, and sedating them for a long period of time include the risks of negatively affecting the short-term pulmonary outcome, length of hospital stay, and neurodevelopment later in infancy. [14][15][16] Nevertheless, it is important that clinicians be aware that if a patient is agitated because of the mechanical ventilation process, sedation should be considered and used. However, agitation is one symptom of hypoxemia, and clinicians must first determine the cause of any agitation in a NICU patient and address that cause.…”

Section: Discussionmentioning

confidence: 99%

Reducing Unplanned Extubations in the NICU

et al. 2014

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BACKGROUND AND OBJECTIVES: Unplanned extubation can be a significant event that places the patient at risk for adverse events. Our goal was to reduce unplanned extubations to <1 unplanned extubation per 100 patient-intubated days. METHODS: All unplanned extubations in the NICU beginning in October 2009 were audited. Data collected included time of day, patient weight, and patient care activity at the time of the event. Bundles of potentially better practices were implemented in sequential Plan-Do-Study-Act cycles. Rates of unplanned extubation (number per patient-intubated day) for each month were analyzed by using control charts, and causes of unplanned extubation were analyzed by using Pareto charts. RESULTS: We found a significant decrease in the unplanned extubation rate after implementation of the first bundle of potentially better practices in May 2010 (2.38 to 0.41 per 100 patient-intubated days). Several more Plan-Do-Study-Act cycles were conducted to sustain this improvement. A persistent reduction in the unplanned extubation rate (0.58 per 100 patient-intubated days) began in February 2013. Causes included dislodgement during care and procedures and variation in the fixation of the endotracheal tube. The majority of events occurred in very low birth weight infants during the daytime shift. CONCLUSIONS: Unplanned extubations in the NICU can be reduced by education of staff and by implementing standard practices of care. Sustainability of any practice change to improve quality is critically dependent on culture change within the NICU. We suggest that the benchmark for unplanned extubation should be a rate <1 per 100 patient-intubated days.

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“…A recent systematic review reported limited favorable effect with selective rather than routine use of opioids for analgesia in mechanically ventilated infants. 92 Concerns have been raised for adverse short-and long-term neurodevelopmental outcomes related to the use of morphine infusions in preterm neonates. 92,93 However, a follow-up study in ninety 8-to 9-year-olds who had previously participated in 1 RCT comparing continuous morphine infusion with placebo found that low-dose morphine infusion did not affect cognition or behavior and may have had a positive effect on everyday executive functions for these children.…”

Section: Opioids Benzodiazepines and Other Drugsmentioning

confidence: 99%

“…92 Concerns have been raised for adverse short-and long-term neurodevelopmental outcomes related to the use of morphine infusions in preterm neonates. 92,93 However, a follow-up study in ninety 8-to 9-year-olds who had previously participated in 1 RCT comparing continuous morphine infusion with placebo found that low-dose morphine infusion did not affect cognition or behavior and may have had a positive effect on everyday executive functions for these children. 87 A 2008 Cochrane systematic review found insufficient evidence to recommend the routine use of opioids in mechanically ventilated infants.…”

Section: Opioids Benzodiazepines and Other Drugsmentioning

confidence: 99%

Prevention and Management of Procedural Pain in the Neonate: An Update

Keels¹,

Sethna²,

Watterberg³

et al. 2016

Pediatrics

333

171

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The prevention of pain in neonates should be the goal of all pediatricians and health care professionals who work with neonates, not only because it is ethical but also because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor, yet painful procedures. Therefore, every health care facility caring for neonates should implement (1) a pain-prevention program that includes strategies for minimizing the number of painful procedures performed and (2) a pain assessment and management plan that includes routine assessment of pain, pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and measures for minimizing pain associated with surgery and other major procedures.

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Opioids for neonates receiving mechanical ventilation: a systematic review and meta-analysis

Abstract: There is insufficient evidence to recommend routine use of opioids in mechanically ventilated newborns. Opioids should be used selectively, when indicated by clinical judgment and evaluation of pain indicators. If sedation is required, morphine is safer than midazolam.

Cited by 118 publications

References 46 publications

Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study

Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study

Reducing Unplanned Extubations in the NICU

Prevention and Management of Procedural Pain in the Neonate: An Update

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