Impact of Early Methadone Initiation in Critically Injured Burn Patients

Abstract

Numerous studies have identified strategies to reduce mechanical ventilation duration by targeting appropriate sedation levels. However, applicability of these strategies to critically injured patients with burn injury has not been established. At our medical center, methadone is commonly used early in the care of burn patients to treat background pain and limit the development of opioid tolerance. The aim of this study is to evaluate the effect of early methadone initiation in critically injured burn patients requiring mechanical ventilation. This retrospective study compared patients who received early methadone with patients who did not while mechanically ventilated with the primary outcome of ventilator-free days in a 28-day period. Those who received methadone within 4 days of intubation and remained ventilated for 2 days after the first dose were included in the methadone group. Propensity scores were used to match up to three control patients to each methadone patient. Seventy patients (18 methadone and 52 matched control patients) were included in the final evaluation. Patients in the methadone group averaged 16.5 ventilator-free days compared with 11.5 in the control group (P = .03). There was no statistical difference in the duration of intensive care unit or hospital length of stay between groups. Our results suggest that early methadone initiation may have a significant effect on ventilator outcomes in critically injured patients with burn injury. However, further research is warranted.

The use of methadone to facilitate opioid weaning in pediatric critical care patients: a systematic review of the literature and meta‐analysis

“…In adult intensive care, methadone has been used successfully to facilitate narcotic weaning, reducing the duration of opioid infusion and the length of exposure to mechanical ventilation in specific populations . Transitioning to a long‐acting opioid such as methadone is a generally accepted approach to narcotic weaning in pediatric patients .…”

Pain and the Thermally Injured Patient—A Review of Current Therapies

“…1,5,[29][30][31] Methadone is a potent analgesic, is an effective alternative analgesic in opioid-tolerant patients, is used to treat opioid dependence, and can also attenuate central sensitization. 5,29,30,32 Jones et al 5 suggested that early use of methadone leads to better outcomes for burn patients. In fact, in a retrospective pilot study, Jones found that mechanically ventilated patients who received early methadone treatment had an increase in the number of ventilator-free days.…”

“…7,8 Poor pain control also decreases patient compliance with rehabilitation therapy and negatively affects the confidence of the patient in the burn team. 1,5 Thompson et al 9 showed that patient's discomfort during medical procedures impedes on wound care, increases the risk of wound infection, decreases the patient's ability to perform the usual range of motion exercises, increases psychological stress, and is associated with longer hospitalizations.…”

“…[1][2][3][4] In fact, the literature suggests that burn pain is one of the most difficult to manage. 2,[4][5][6] Pain control is very important as inadequate pain control has short-and long-term consequences for the patients. Acute uncontrolled pain has been shown to increase the incidence of mental health disorders in patients (depression, posttraumatic stress disorder) and correlates with increased incidence of attempted suicide after discharge.…”