Methadone Is Effective, Safe in Mechanical Ventilation

Background: Pain afflicts many ICU patients and is particularly problematic among some. Analgesics, especially opioids, are usually prescribed, leading to greater patient comfort and easier ventilation. Studies have suggested worse outcomes in deep sedation and analgesia and may be associated with prolonged ventilatory dependence and other adverse outcomes. Methadone is a synthetic opioid with prolonged μ-receptor agonism and agonism at the κ and σ-1 receptors. Methadone also inhibits the reuptake of monoamines and catecholamines and is a non-competitive antagonist of the N -methyl-aspartate-d-aspartate (NMDA) receptor improving analgesia, efficacy in neuropathic pain without leading to acute opioid tolerance. Methadone is inexpensive and may be easily administered either enterally or parenterally. Objective: To study the use of methadone among mechanically ventilated ICU patients and assess its effect on duration of mechanical ventilation and other outcomes. Design: Systematic revie more...