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Low dose of morphine to relieve dyspnea in acute respiratory failure: the OpiDys double-blind randomized controlled trial
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Low dose of morphine to relieve dyspnea in acute respiratory failure: the OpiDys double-blind randomized controlled trial
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Journal Article
Low dose of morphine to relieve dyspnea in acute respiratory failure: the OpiDys double-blind randomized controlled trial
2024
Overview
Background
Morphine relieves dyspnea in various clinical circumstances. Whether or not this applies to patients admitted to intensive care units (ICUs) for acute respiratory failure (ARF) is unknown. We evaluated the efficacy and safety of low-dose morphine on dyspnea in patients admitted to the ICU for ARF.
Methods
In this single-center, double-blind, phase 2, randomized, controlled trial, we assigned non-intubated adults admitted to the ICU for ARF with severe dyspnea, defined by a visual analog scale for dyspnea (dyspnea-VAS) from zero (no dyspnea) to 100 mm (worst imaginable dyspnea) ≥40 mm, to receive a low dose of Morphine Hydrochloride (intravenous titration followed by subcutaneous relay) or Placebo. All patients received standard therapy, including etiological treatment and non-invasive respiratory support.
Results
Twenty-two patients were randomized, 11 in each group. The average dyspnea (median [interquartile range]) over 24 hours did not significantly differ between the two groups (40 [25 – 43] mm in the Morphine group vs. 40 [36 – 49] mm in the Placebo group,
p
=0.411). Dyspnea-VAS was lower in the Morphine group than in the Placebo group at the end of intravenous titration (30 [11 – 30] vs. 35 [30 – 44],
p
=0.044) and four hours later (18 [10 – 29] vs. 50 [30 – 60],
p
=0.043). The cumulative probability of intubation was higher in the Morphine group than in the Placebo group (
p
=0.046)
Conclusion
In this phase 2 pilot trial, morphine did not improve 24-hour average dyspnea in adult patients with ARF, even though it had a statistically significant immediate effect. Of concern, Morphine use was associated with a higher intubation rate.
Trial registration
The protocol was declared on the ClinicalTrial.gov database (no. NCT04358133) and was published in September 2022.
Publisher
BioMed Central,BioMed Central Ltd,Nature Publishing Group,BMC
Subject
Acute respiratory distress syndrome
/ Adult
/ Aged
/ Analgesics, Opioid - administration & dosage
/ Analgesics, Opioid - adverse effects
/ Anxiety
/ Complications and side effects
/ Dyspnea
/ Female
/ Humans
/ Male
/ Medicine
/ Morphine
/ Morphine - administration & dosage
/ Patients
/ Placebos
/ Pneumology/Respiratory System
/ Respiratory Insufficiency - diagnosis
/ Respiratory Insufficiency - drug therapy
/ Testing
/ Trial
