Methadone’s Effect on Cardiac Repolarization: Safety in the PICU
| Autor: | Joshua R. Kovach, Samantha D Friedman, Nathan E. Thompson |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
education.field_of_study Heart disease medicine.diagnostic_test business.industry Population Boxed warning 030208 emergency & critical care medicine Retrospective cohort study Critical Care and Intensive Care Medicine medicine.disease 03 medical and health sciences 0302 clinical medicine Interquartile range 030225 pediatrics Pediatrics Perinatology and Child Health Emergency medicine Cohort Medicine business education Electrocardiography Methadone medicine.drug |
| Zdroj: | Pediatric Critical Care Medicine. 21:e747-e751 |
| ISSN: | 1529-7535 |
| DOI: | 10.1097/pcc.0000000000002492 |
| Popis: | Objectives Opioids are routinely used in the PICU. Methadone is an effective method of preventing and treating iatrogenic opioid withdrawal; however, it carries an Food and Drug Administration Boxed Warning due to the potential to prolong the corrected QT interval and potentially lead to life-threatening arrhythmias. Guidelines on the safe use of methadone have limited applicability to children since their cardiac intervals differ from those of adults. There is little data on the electrophysiologic effects in the pediatric population. We set out to describe the safety of methadone use in the PICU, hypothesizing that methadone does not cause a significant change in corrected QT interval from baseline. Design Retrospective cohort study. Setting Children's Hospital of Wisconsin, Milwaukee, WI. Patients Fifty-one patients, age less than or equal to 18 years old, initiated on methadone during PICU admission, over an 11-month period, for the prevention or treatment of opioid withdrawal. Interventions Retrospective data queried from the electronic health record and stored telemetry waveforms obtained from an automated real-time patient data acquisition software system (BedMasterEx; Anandic Medical Systems AG, Feuerthalen, Switzerland). Measurements and main results Corrected QT intervals were not significantly different at 12 hours, 96 hours, or PICU discharge (p values: 0.57, 0.54, and 0.34) when compared to baseline. The median change in corrected QT from baseline to 12 hours after the first dose of methadone was 5 ms (interquartile range, -12 to 11 ms), 0 ms to steady state (interquartile range, -18 to 18 ms), and 5 ms from baseline to 12 hours after the highest dose of methadone (interquartile range, -14 to 16 ms). The most common primary diagnosis was structural heart disease (29% of subjects) in our cohort and every subject that experienced an increase in corrected QT interval greater than or equal to 40 ms had some form of structural heart disease. Conclusions Methadone did not significantly prolong the corrected QT interval in a population of critically ill children, suggesting that it can be safely used in this population, although patients with structural heart disease may warrant closer monitoring. |
| Databáze: | OpenAIRE |
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