Fentanyl infusion in a multi-organ failure patient on adaptive support ventilation: a conundrum

Abstract

The authors present a case of an 85-year-old male patient with multiple co-morbidities. He underwent laparotomy for carcinoma rectum, recovered from anesthesia, and was shifted to the ward. On sixth day his condition deteriorated, so was shifted to ICU. In ICU, he was put on ventilator in ASV mode, and fentanyl infusion started. The next morning a high V_T of 900-1000 mL was noticed to be delivered, while the respiratory rate was 8-10/min. Naloxone administration eased the respiratory parameters. Careful monitoring of sedation levels and respiratory drive becomes crucial for preventing volutrauma in ASV mode of ventilation.

Abbreviations: ASV - Adaptive support ventilation, FiO₂ - Fraction of inspired Oxygen, MV - minute ventilation, PEEP - positive end expiratory pressure, RASS - Richmond Agitation Sedation Scale, RR - respiratory rate, Vt - tidal volume

Keywords: Closed loop ventilation, Complication, Opioids, Volutrauma

Citation: Kukanti C,  Karim HMR, Panda CK, Jain A. Fentanyl infusion in a multi-organ failure patient on adaptive support ventilation: a conundrum. Anaesth. pain intensive care 2024;28(3):608−610; DOI: 10.35975/apic.v28i3.2044

Received: February 20, 2024; Accepted: March 31, 2024