Intranasal fentanyl for respiratory distress in children and adolescents with life-limiting conditions

Lucas Pieper,Boris Zernikow,Julia Wager

doi:10.1186/s12904-018-0361-x

Lucas Pieper, Boris Zernikow + Show 1 more

Open Access

https://doi.org/10.1186/s12904-018-0361-x

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Abstract

BackgroundRespiratory distress is one of the most common and frightening symptoms of children with life-limiting conditions. Because treatment of the underlying cause is frequently impossible or insufficient, in many children, symptomatic treatment is warranted. The purpose of this study was to describe the circumstances of the use of intranasal fentanyl in an acute attack of respiratory distress (AARD) in children receiving palliative care, as well as to describe outcomes and adverse events after its use.MethodsChildren and adolescents treated in a pediatric palliative unit or attended by a specialized home care team between 2010 and 2016 were included in this study. A retrospective chart review was conducted of those who were treated with intranasal fentanyl for an AARD.ResultsDuring the study period 16 children (0.5–18.6 years) with various life-limiting conditions were treated with intranasal fentanyl for AARD. In total, 70 AARDs were analyzed. In 74% of all AARDs, a single dose of intranasal fentanyl was used. Frequent causes for an AARD were excessive secretions and acute respiratory infection. The median starting dose of intranasal fentanyl was 1.5 μg/kg body weight. Labored breathing (96%), tachypnea (79%) and related suffering (97%) improved after treatment. An adverse event occurred in one child.ConclusionsIntranasal fentanyl may be a safe and effective medication for the treatment of acute attacks of respiratory distress in children with life-limiting conditions. However, prospective studies with larger sample sizes and a control group are needed to validate these findings.

Highlights

Respiratory distress is one of the most common and frightening symptoms of children with life-limiting conditions
Beside the previous report of intranasal fentanyl (INF) in eleven infants and newborns [37], this is the first study that describes the usage of INF for the treatment of Respiratory distress (RD) in children with Life-limiting conditions (LLC) receiving palliative care
The results show that in many children of various ages and with varying diagnosis, symptoms improve after the first INF application; Fig. 2 Conditions after the first intranasal fentanyl dose

Summary

Introduction

Respiratory distress is one of the most common and frightening symptoms of children with life-limiting conditions. Respiratory distress (RD) is a concerning symptom with high prevalence in children with life-limiting conditions (LLCs) [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15]. In children and adolescents of all ages, RD can occur with a wide range of physical signs and unpleasant perceptions [16]. The latter are often described as dyspnea,. RD can be caused by increased respiratory drive, mechanical impedance, respiratory muscle failure, wasted ventilation and psychological stress [19] causing sensations such as air hunger, a sense of increased work of breathing, labored breathing and chest tightness [20, 21]

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