Pharmacokinetics of Opioid Infusions in the Adult Intensive Care Unit Setting—A Systematic Review

Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, Watson PL, Weinhouse GL, Nunnally ME, Rochwerg B, Balas MC, van den Boogaard M, Bosma KJ, Brummel NE, Chanques G, Denehy L, Drouot X, Fraser GL, Harris JE, Joffe AM, Kho ME, Kress JP, Lanphere JA, McKinley S, Neufeld KJ, Pisani MA, Payen JF, Pun BT, Puntillo KA, Riker RR, Robinson BRH, Shehabi Y, Szumita PM, Winkelman C, Centofanti JE, Price C, Nikayin S, Misak CJ, Flood PD, Kiedrowski K, Alhazzani W. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):e825–73. https://doi.org/10.1097/CCM.0000000000003299.

Article  PubMed  Google Scholar 

de Haro C, Magrans R, López-Aguilar J, Montanyà J, Lena E, Subirà C, Fernandez-Gonzalo S, Gomà G, Fernández R, Albaiceta GM, Skrobik Y, Lucangelo U, Murias G, Ochagavia A, Kacmarek RM, Rue M, Blanch L; Asynchronies in the Intensive Care Unit (ASYNICU) Group. Effects of sedatives and opioids on trigger and cycling asynchronies throughout mechanical ventilation: an observational study in a large dataset from critically ill patients. Crit Care. 2019 Jul 5;23(1):245. https://doi.org/10.1186/s13054-019-2531-5. PMID: 31277722.

Duprey MS, Dijkstra-Kersten SMA, Zaal IJ, Briesacher BA, Saczynski JS, Griffith JL, Devlin JW, Slooter AJC. Opioid use increases the risk of delirium in critically ill adults independently of pain. Am J Respir Crit Care Med. 2021;204(5):566–72. https://doi.org/10.1164/rccm.202010-3794OC. (PMID: 33835902).

Article  PubMed  PubMed Central  Google Scholar 

Moran BL, Myburgh JA, Scott DA. The complications of opioid use during and post-intensive care admission: a narrative review. Anaesth Intensive Care. 2022;50(1–2):108–26. https://doi.org/10.1177/0310057X211070008. (Epub 2022 Feb 16).

Article  PubMed  Google Scholar 

Devlin JW, Mallow-Corbett S, Riker RR. Adverse drug events associated with the use of analgesics, sedatives, and antipsychotics in the intensive care unit. Crit Care Med. 2010;38(6 Suppl):S231–43. https://doi.org/10.1097/CCM.0b013e3181de125a.

Article  CAS  PubMed  Google Scholar 

Wang PP, Huang E, Feng X, Bray CA, Perreault MM, Rico P, Bellemare P, Murgoi P, Gélinas C, Lecavalier A, Jayaraman D, Frenette AJ, Williamson D. Opioid-associated iatrogenic withdrawal in critically ill adult patients: a multicenter prospective observational study. Ann Intensive Care. 2017;7(1):88. https://doi.org/10.1186/s13613-017-0310-5.

Article  PubMed  PubMed Central  Google Scholar 

Duceppe MA, Perreault MM, Frenette AJ, Burry LD, Rico P, Lavoie A, Gélinas C, Mehta S, Dagenais M, Williamson DR. Frequency, risk factors and symptomatology of iatrogenic withdrawal from opioids and benzodiazepines in critically ill neonates, children and adults: a systematic review of clinical studies. J Clin Pharm Ther. 2019;44(2):148–56. https://doi.org/10.1111/jcpt.12787. (Epub 2018 Dec 19).

Article  PubMed  Google Scholar 

Khan F, Mehan A. Addressing opioid tolerance and opioid-induced hypersensitivity: recent developments and future therapeutic strategies. Pharmacol Res Perspect. 2021;9(3): e00789. https://doi.org/10.1002/prp2.789.

Article  PubMed  PubMed Central  Google Scholar 

Fox MA, Carothers C, Dircksen KK, Birrer KL, Choi MJ, Mukkera SR. prevalence and risk factors for iatrogenic opioid withdrawal in medical critical care patients. Crit Care Explor. 2023;5(5): e0904. https://doi.org/10.1097/CCE.0000000000000904.

Article  PubMed  PubMed Central  Google Scholar 

Bolesta S, Burry L, Perreault MM, Gélinas C, Smith KE, Eadie R, Carini FC, Saltarelli K, Mitchell J, Harpel J, Stewart R, Riker RR, Fraser GL, Erstad BL; AduLt iatrogEnic withdRawal sTudy in the ICU (ALERT-ICU) Study Investigators. International analgesia and sedation weaning and withdrawal practices in critically ill adults: the adult iatrogenic withdrawal study in the ICU. Crit Care Med. 2023 Nov 1;51(11):1502-1514. https://doi.org/10.1097/CCM.0000000000005951. Epub 2023 Jun 7

Morales Castro D, Dresser L, Granton J, Fan E. Pharmacokinetic alterations associated with critical illness. Clin Pharmacokinet. 2023;62(2):209–20. https://doi.org/10.1007/s40262-023-01213-x. (Epub 2023 Feb 2).

Article  PubMed  PubMed Central  Google Scholar 

Roberts DJ, Hall RI. Drug absorption, distribution, metabolism and excretion considerations in critically ill adults. Expert Opin Drug Metab Toxicol. 2013;9(9):1067–84. https://doi.org/10.1517/17425255.2013.799137. (Epub 2013 May 17).

Article  CAS  PubMed  Google Scholar 

Smith BS, Yogaratnam D, Levasseur-Franklin KE, Forni A, Fong J. Introduction to drug pharmacokinetics in the critically ill patient. Chest. 2012;141(5):1327–36. https://doi.org/10.1378/chest.11-1396.

Article  CAS  PubMed  Google Scholar 

McKindley DS, Hanes S, Boucher BA. Hepatic drug metabolism in critical illness. Pharmacotherapy. 1998 Jul-Aug;18(4):759-78. PMID: 9692650.

Charlton M, Thompson JP. Pharmacokinetics in sepsis. BJA Educ. 2019;19(1):7–13. https://doi.org/10.1016/j.bjae.2018.09.006. (Epub 2018 Nov 9).

Article  CAS  PubMed  Google Scholar 

Blanco VE, Hernandorena CV, Scibona P, Belloso W, Musso CG. Acute kidney injury pharmacokinetic changes and its impact on drug prescription. Healthcare (Basel). 2019;7(1):10. https://doi.org/10.3390/healthcare7010010.

Article  PubMed  PubMed Central  Google Scholar 

Lea-Henry TN, Carland JE, Stocker SL, Sevastos J, Roberts DM. Clinical pharmacokinetics in kidney disease: fundamental principles. Clin J Am Soc Nephrol. 2018;13(7):1085–95. https://doi.org/10.2215/CJN.00340118. (Epub 2018 Jun 22).

Article  CAS  PubMed  PubMed Central  Google Scholar 

Vilay AM, Churchwell MD, Mueller BA. Clinical review: drug metabolism and nonrenal clearance in acute kidney injury. Crit Care. 2008;12(6):235. https://doi.org/10.1186/cc7093. Epub 2008 Nov 12.

Dixon J, Lane K, Macphee I, Philips B. Xenobiotic metabolism: the effect of acute kidney injury on non-renal drug clearance and hepatic drug metabolism. Int J Mol Sci. 2014;15(2):2538–53. https://doi.org/10.3390/ijms15022538.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Shekar K, Fraser JF, Smith MT, Roberts JA. Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation. J Crit Care. 2012;27(6):741.e9-18. https://doi.org/10.1016/j.jcrc.2012.02.013.

Article  CAS  PubMed  Google Scholar 

Bugge JF. Influence of renal replacement therapy on pharmacokinetics in critically ill patients. Best Pract Res Clin Anaesthesiol. 2004;18(1):175–87. https://doi.org/10.1016/j.bpa.2003.09.002.

Article  CAS  PubMed  Google Scholar 

Kanji S, Williamson D, Hartwick M. Potential pharmacological confounders in the setting of death determined by neurologic criteria: a narrative review. Can J Anaesth. 2023;70(4):713–23. https://doi.org/10.1007/s12630-023-02415-4. (Epub 2023 May 2).

Article  PubMed  PubMed Central  Google Scholar 

Tse AHW, Ling L, Lee A, Joynt GM. Altered pharmacokinetics in prolonged infusions of sedatives and analgesics among adult critically ill patients: a systematic review. Clin Ther. 2018;40(9):1598-1615.e2. https://doi.org/10.1016/j.clinthera.2018.07.021.

Article  CAS  PubMed  Google Scholar 

Choi L, Ferrell BA, Vasilevskis EE, Pandharipande PP, Heltsley R, Ely EW, Stein CM, Girard TD. Population pharmacokinetics of fentanyl in the critically ill. Crit Care Med. 2016;44(1):64–72. https://doi.org/10.1097/CCM.0000000000001347.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;29(372): n71. https://doi.org/10.1136/bmj.n71.

Article  Google Scholar 

Bjelland TW, Klepstad P, Haugen BO, Nilsen T, Dale O. Effects of hypothermia on the disposition of morphine, midazolam, fentanyl, and propofol in intensive care unit patients. Drug Metab Dispos. 2013;41(1):214–23. https://doi.org/10.1124/dmd.112.045567. (Epub 2012 Oct 31).

Article  CAS  PubMed  Google Scholar 

Alazia M, Levron JC. Etude pharmacocinétique d'une perfusion intraveineuse prolongée de fentanyl en réanimation [Pharmacokinetic study of prolonged infusion of fentanyl in intensive care]. Ann Fr Anesth Reanim. 1987;6(5):465-6. French. https://doi.org/10.1016/s0750-7658(87)80376-3.

Baldwin F, Gray R, Boyd O, Waxman D, Patel B, Allen M, Scutt G. Safe prognostication following cardiac arrest: The role of the pharmacokinetics of fentanyl in patients treated with targeted temperature management. Resuscitation. 2020;149:10–6. https://doi.org/10.1016/j.resuscitation.2020.01.028. (Epub 2020 Feb 6).

Article  CAS  PubMed  Google Scholar 

Shafer A, White PF, Schüttler J, Rosenthal MH. Use of a fentanyl infusion in the intensive care unit: tolerance to its anesthetic effects? Anesthesiology. 1983;59(3):245–8.

CAS  PubMed  Google Scholar 

Bion JF, Logan BK, Newman PM, Brodie MJ, Oliver JS, Aitchison TC, Ledingham IM. Sedation in intensive care: morphine and renal function. Intensive Care Med. 1986;12(5):359–65. https://doi.org/10.1007/BF00292926.

Article  CAS  PubMed  Google Scholar 

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