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Original Article
Pharmacology
Comparison of the efficacy of an infusion pump or standard IV push injection to deliver naloxone in treatment of opioid toxicity
Bita Dadpour, Maryam Vahabzadeh, Babak Mostafazadeh
Acute Crit Care. 2020;35(1):38-43.   Published online February 29, 2020
DOI: https://doi.org/10.4266/acc.2020.00010
  • 6,822 View
  • 166 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Background
The optimal goal of naloxone infusion in intensive care units is to ameliorate opioid-induced side effects in therapy or eliminate the symptoms of opioid toxicity in overdoses. Accurately monitoring and regulating the doses is critical to prevent adverse effects related to naloxone administration. The present study aimed to compare treatment outcomes when using two methods of intravenous naloxone infusion: an infusion pump or the standard method. Methods: This study involved 80 patients with signs and symptoms of opioid overdose. The patients were randomly assigned into two groups with respect to intravenous infusion of naloxone by either an infusion pump or the standard method. Results: Comparison of study parameters between the two groups at 12 and 24 hours after intervention showed significantly more compensatory acid-base imbalance in the naloxone infusion pump group. In the group that received naloxone by pump, only one patient experienced withdrawal symptoms, but withdrawal symptoms appeared in 12 patients (30.0%) in the standard intravenous infusion group within 12 hours and in seven additional patients (17.5%) within 24 hours of intervention. In the group receiving pump-based naloxone infusion therapy, no another complications were reported; however in the standard infusion group, the 12-hour and 24-hour complication rates were 55.0% and 32.5%, respectively. The length of hospital stay was 2.85±1.05 and 4.22±0.92 days for the pump and standard infusion groups, respectively (P<0.001). Conclusions: Naloxone infusion using an infusion pump may be safer with regard to hemodynamic stability, resulting in shorter hospitalization periods, and fewer posttreatment complications.

Citations

Citations to this article as recorded by  
  • Endogenous opiates and behavior: 2020
    Richard J. Bodnar
    Peptides.2022; 151: 170752.     CrossRef
  • Are opioid receptor antagonists adequate for “Opioid” overdose in a changing reality?
    John F. Peppin, Joseph V. Pergolizzi, Albert Dahan, Robert B. Raffa
    Journal of Clinical Pharmacy and Therapeutics.2021; 46(4): 861.     CrossRef
  • The Efficacy, Safety, and Convenience of a New Device for Flushing Intravenous Catheters (Baro Flush™): A Prospective Study
    Youn I. Choi, Jae Hee Cho, Jun-Won Chung, Kyoung Oh Kim, Kwang An Kwon, Han Yong Chun, Dong Kyun Park, Yoon Jae Kim
    Medicina.2020; 56(8): 393.     CrossRef
Case Report
Pharmacology
Recurrent Desaturation Events due to Opioid-Induced Chest Wall Rigidity after Low Dose Fentanyl Administration
Sung Yeon Ham, Bo Ra Lee, Taehoon Ha, Jeongmin Kim, Sungwon Na
Korean J Crit Care Med. 2016;31(2):118-122.   Published online May 31, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.2.118
  • 23,748 View
  • 402 Download
  • 5 Crossref
AbstractAbstract PDF
Opioid-induced chest wall rigidity is an uncommon complication of opioids. Because of this, it is often difficult to make a differential diagnosis in a mechanically ventilated patient who experiences increased airway pressure and difficulty with ventilation. A 76-year-old female patient was admitted to the intensive care unit (ICU) after surgery for periprosthetic fracture of the femur neck. On completion of the surgery, airway pressure was increased, and oxygen saturation fell below 95% after a bolus dose of fentanyl. After ICU admission, the same event recurred. Manual ventilation was immediately started, and a muscle relaxant relieved the symptoms. There was no sign or symptom suggesting airway obstruction or asthma on physical examination. Early recognition and treatment should be made in a mechanically ventilated patient experiencing increased airway pressure in order to prevent further deterioration.

Citations

Citations to this article as recorded by  
  • Fentanyl-Induced Rigid Chest Syndrome in Critically Ill Patients
    Alison J. Tammen, Donald Brescia, Dan Jonas, Jeremy L. Hodges, Philip Keith
    Journal of Intensive Care Medicine.2023; 38(2): 196.     CrossRef
  • Effects of fentanyl overdose-induced muscle rigidity and dexmedetomidine on respiratory mechanics and pulmonary gas exchange in sedated rats
    Philippe Haouzi, Nicole Tubbs
    Journal of Applied Physiology.2022; 132(6): 1407.     CrossRef
  • Challenges in Sedation Management in Critically Ill Patients with COVID-19: a Brief Review
    Kunal Karamchandani, Rajeev Dalal, Jina Patel, Puneet Modgil, Ashley Quintili
    Current Anesthesiology Reports.2021; 11(2): 107.     CrossRef
  • A Case of Masseter Muscle Rigidity during Awake Intubation under Remifentanil Infusion
    Tomoki YAMAGA, Takeshi NEGITA, Masayo SUGIURA, Nobuyuki KIMURA
    THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA.2019; 39(3): 274.     CrossRef
  • Opioids and Chest Wall Rigidity During Mechanical Ventilation
    Jeffrey P. Roan, Navin Bajaj, Field A. Davis, Natalie Kandinata
    Annals of Internal Medicine.2018; 168(9): 678.     CrossRef
Review
Pharmacology
Assessment and Treatment of Pain in Adult Intensive Care Unit Patients
Jun Mo Park, Ji Hyun Kim
Korean J Crit Care Med. 2014;29(3):147-159.   Published online August 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.3.147
  • 18,150 View
  • 699 Download
  • 3 Crossref
AbstractAbstract PDF
In most cases, patients admitted to an intensive care unit (ICU) have suffered from severe trauma, undergone major surgery or been treated for a serious medical illness. Although they often experience more intense pain than general ward patients, they are frequently unable to communicate their experiences to health care providers, thus preventing accurate assessment and treatment of their pain. If appropriate measures are not taken to treat pain in critically ill patients, stress response or sympathetic overstimulation can lead to complications. The short-term consequences of untreated pain include higher energy expenditure and immunomodulation. Longer-term, untreated pain increases the risk of post-traumatic stress disorder. Because pain is quite subjective, the accurate assessment of pain is very difficult in the patients with impaired communication ability. The current most valid and reliable behavioral pain scales used to assess pain in adult ICU patients are the Behavioral Pain Scale and the Critical-Care Pain Observation Tool. Once pain has been accurately assessed using these methods, various pharmacologic and non-pharmacologic therapies should be performed by the multidisciplinary care team. Accurate assessment and proper treatment of pain in adult ICU patients will improve patients outcome, which reduces the stress response and decreases the risk of post-traumatic stress disorder.

Citations

Citations to this article as recorded by  
  • Nurses’ knowledge, practice, and associated factors of pain assessment in critically ill adult patients at public hospitals, Addis Ababa, Ethiopia
    Temesgen Ayenew, Berhanu Melaku, Mihretie Gedfew, Haile Amha, Keralem Anteneh Bishaw
    International Journal of Africa Nursing Sciences.2021; 15: 100361.     CrossRef
  • Impact of Pain Management Algorithm on Pain Intensity of Patients with Loss of Consciousness Hospitalized in Intensive Care Unit: A Clinical Trial
    Zahra Dehghani, Asadollah Keikhaei, Fariba Yaghoubinia, Aliakbar Keykha, Masoom Khoshfetrat
    Medical - Surgical Nursing Journal.2019;[Epub]     CrossRef
  • Ignorance may be Bliss (for Intensivists), but not for ICU Patients!
    Atul P. Kulkarni, Sumitra G Bakshi
    Indian Journal of Critical Care Medicine.2019; 23(4): 161.     CrossRef

ACC : Acute and Critical Care