Evaluation of an opiate-weaning protocol using methadone in pediatric intensive care unit patients

OBJECTIVE: To evaluate the efficacy of a standardized opiate-weaning protocol using methadone compared with methadone weaning before protocol development. DESIGN: Time series, prospective study with comparison to historical controls. SETTING: Twenty-bed medical-surgical intensive care unit in an academic children's hospital. PATIENTS: Ten children, aged 6 months to 18 yrs, who received methadone for weaning from continuous opiate infusions for >or=7 days compared with ten patients undergoing weaning by standardized protocol. INTERVENTIONS: Institution of standardized opiate-weaning protocol. MEASUREMENTS AND MAIN RESULTS: Patient age, gender, and diagnosis were similar in both nonprotocol (NP) and protocol (P) groups (p = NS). Days of opiate use were also similar between groups. Nine of ten NP and seven of ten P patients were on continuous fentanyl infusions, and the remainder were on continuous morphine infusions. P patients were weaned significantly faster than NP patients (median, 9 days and 20 days, respectively; p <.001). P patients requiring short-term opiate use also weaned significantly faster than short-term NP patients (median, 5 days and 21.5 days, respectively; p <.001). Withdrawal complications were seen in three NP patients with weaning delayed in two. Two P patients had withdrawal complications with no delay in weaning (p = NS). Significant methadone calculation discrepancy occurred in one NP patient but in no P patients. CONCLUSIONS: Pediatric intensive care unit patients requiring prolonged opiate use can be weaned by using methadone with minimal signs of withdrawal. Use of a standardized weaning protocol decreased time for weaning without increasing the frequency rate of withdrawal symptoms.