Objectives: To study the effect of extracorporeal membrane oxygenation (ECMO) on the pharmacokinetics of morphine in infants.
Design: A prospective, comparative study of morphine pharmacokinetics during and after ECMO.
Setting: The pediatric intensive care unit at a children's hospital.
Patients: Seven infants, aged 1 day to 12 months, requiring ECMO.
Intervention: Infusion of morphine.
Measurement and main results: Steady-state concentrations of morphine were used to generate a morphine clearance rate. Plasma clearance rate of morphine increased from 0.574 +/- 0.3 L/kg/hr to 1.058 +/- 0.727 L/kg/hr after discontinuation of ECMO (p < .01). Two infants experienced a clinical picture consistent with opioid withdrawal.
Conclusion: Infants requiring morphine after ECMO may require higher dose rates to maintain adequate sedation.