Abstract
Objective
To describe the use and efficacy of nebulized naloxone in patients with suspected
opioid intoxication.
Methods
This was an observational study conducted at an inner city emergency department. Patients
were eligible if they had self-reported or suspected opioid intoxication and a spontaneous
respiratory rate ≥6 breaths/minute. Nebulized naloxone (2 mg in 3 mL normal saline) was administered
through a standard face mask at the discretion of the treating physician. Structured
data collection included demographics, vital signs pre and post naloxone administration
and adverse events. The primary outcome was level of consciousness, which was recorded
pre and 15 minutes postnaloxone administration using the Glasgow Coma Scale (GCS)
and the Richmond Agitation Sedation Scale (RASS).
Results
Of the 73 patients who presented with suspected opioid intoxication and were given
naloxone over the study period, 26 were initially treated with nebulized naloxone.
After nebulized naloxone administration, median GCS improved from 11 [interquartile
range (IQR) 3.5] to 13 (IQR, 2.5), P = .001. Median RASS improved from −3.0 (IQR, −1.0) to −2.0 (IQR, −1.5), P < .0001. Need for supplemental oxygen decreased from 81% to 50%, P = .03. Vital signs did not differ pre/post therapy. There were few adverse effects
from nebulized naloxone administration: 12% experienced moderate-severe agitation,
8% were diaphoretic and none vomited. Eleven required subsequent administrations of
naloxone, nine of whom self-reported using either heroin, methadone or both. Of these,
5 underwent urine drug screening and all 5 tested positive for either opiates or methadone.
Conclusions
Nebulized naloxone was well-tolerated and led to a reduction in the need for supplemental
oxygen as well as improved median GCS and RASS scores in patients with suspected opioid
intoxication.
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Article Info
Publication History
Published online: January 23, 2013
Accepted:
October 3,
2012
Received in revised form:
October 3,
2012
Received:
August 23,
2012
Footnotes
☆There was no funding for this investigation.
☆☆This study was, in part, presented at the Society for Academic Emergency Medicine annual meeting in May, 2009. Haroz R, Patterson RA, Parone DA, Jones MK, Glaspey LJ, Smith NM, Stauss MP, Baumann BM. The efficacy of nebulized naloxone in comparison to intravenous and intranasal formulations. AcadEmerg Med. 2009;16(4):S220.
★This investigation was conducted at Cooper University Hospital, Camden, NJ.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
