Continuous hydromorphone for pain and sedation in mechanically ventilated infants and children

Objective: To describe dosing regimens and efficacy of continuous infusion hydromorphone in mechanically ventilated children.Design: Retrospective review.Setting: Tertiary care, pediatric hospital.Patients: Ninety-two critically ill children (<18 years old).Main outcome measure(s): Hydromorphone dosing requirements, concomitant pain and sedation therapy, patient-specific pain scores (using Face Legs Activity Cry Consolability [FLACC] pain scale), and possible adverse drug events related to therapy.Results: Starting dose was 0.024 ± 0.04 mg/kg/h. Maximum dose was 0.05 ± 0.1 mg/kg/h. Duration of therapy was 182 ± 169 hours. Most patients received additional pain and sedation therapy. Most mean daily FLACC scores (66 percent) were below 1. Less than 10 percent of scores were above 3; only 1 score was above 6. Mean FLACC score, when averaged per patient course, was 1.004 ± 0.71. Extracorporeal membrane oxygenation (ECMO) patients had a significantly higher initial and maximum dosing requirement than non-ECMO patients (p = 0.001).Conclusions: Continuous infusion hydromorphone appears to be an effective adjunctive analgesic in mechanically ventilated children.