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

To describe dosing regimens and efficacy of continuous infusion hydromorphone in mechanically ventilated children.Retrospective review.Tertiary care, pediatric hospital.Ninety-two critically ill children (<18 years old).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.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).Continuous infusion hydromorphone appears to be an effective adjunctive analgesic in mechanically ventilated children.