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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
So Ruth asked a question saying, “Are there any alternatives to opiates, such as fentanyl or morphine in intensive care when someone is in an induced coma, on ventilation with a breathing tube?” Now, it’s a great question to ask. And unfortunately, there are not many alternatives.
So when someone is ventilated with a breathing tube or an endotracheal tube in intensive care, they automatically go into an induced coma. And the standard medications at the moment are, propofol and midazolam or Versed for sedation. And then either morphine or fentanyl for opiates, to enable a patient, to be able to tolerate mechanical ventilation because it’s very, very uncomfortable.
Now, have I seen many alternatives?
So when someone, for example, is allergic to morphine or to fentanyl, you are usually using the other. Now there are some other alternatives such as oxycodone or hydromorphone, but they are also classified as opiates as well.
So unfortunately, there aren’t many alternatives. In some situations, somebody might use Dynastat or parecoxib as an alternative. But that’s not an opiate, but that can cause kidney failure on the other end. And in some countries, it is even banned.
So it’s a tricky situation when someone is in an induced coma, on sedation, and on opiates, because it can take a long time for them to wake up and you want people to wake up fairly quickly because the longer they stay intubated and on a breathing tube or an endotracheal tube, the harder it is for them to get off the ventilator, especially since morphine or fentanyl are addictive in nature.
So if you keep people on morphine or fentanyl for too long, they’re also going often through a withdrawal process, which then prolongs the time someone is on a ventilator. It increases the chances of ICU psychosis and ICU delirium. It increases the chances that someone ends up with a tracheostomy. It increases the chances that someone has a failed extubation, and needs to be reintubated. So the list is fairly long and also it increases the chances that someone gets deconditioned more and more.
So that is my quick tip for today.
If you have a loved one in intensive care, go to intensivecarehotline.com, and call us on one of the numbers on the top of our website. The numbers are also below this video or email us to [email protected].
If you need a medical record review for your loved one in intensive care, go to our medical record review page, and you can book some time there.
And like this video, comment below what you want to see next, or what questions and insights you have. Subscribe to my YouTube channel for updates for families in intensive care, share the video with your family and your friends and click the notification bell.
This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.
Take care.