Opioid and Benzodiazepine Withdrawal Syndrome in PICU Patients: Which Risk Factors Matter?

Opioid and Benzodiazepine Withdrawal Syndrome in PICU Patients: Which Risk Factors Matter?

Author Lucas da Silva, Paulo Sergio Google Scholar
Reis, Maria Eunice Google Scholar
Machado Fonseca, Thais Suelotto Google Scholar
Machado Fonseca, Marcelo Cunio Autor UNIFESP Google Scholar
Abstract Background and Aims:Although iatrogenic withdrawal syndrome (IWS) has been recognized in patients exposed to opioids and benzodiazepines, very few studies have used a validated tool for diagnosis and assessment of IWS in critically ill children. We sought to determine IWS rate, risk factors, and outcomes of IWS patients.Methods:Prospective observational study conducted in a pediatric intensive care unit. A total of 137 patients (31 with IWS and 106 with no IWS) received a continuous infusion of fentanyl and midazolam for 3 or more days. The Sophia Observation withdrawal Symptoms scale was repeatedly applied when children were weaned off sedation/analgesia.Results:The overall incidence of IWS was 22.6%. Of the 31 IWS patients, 6 showed IWS with less than 5 days sedation or analgesia. Logistic regression showed that the median peak dose of midazolam was associated with IWS development (odds ratio 1.4). Receiver-operating curve showed a cut-off value of 0.35mg/kg/h for midazolam peak dose (sensitivity 96.7%, specificity 51%, positive predictive value 36.6%, and negative predictive value 98.2%), with area under the curve of 0.80. IWS patients had a longer time on mechanical ventilation, prolonged pediatric intensive care unit, and hospital stays, and required prolonged period to have drugs discontinued.Conclusions:Although length of sedation/analgesia for at least5 days has been widely proposed for monitoring IWS, our data suggest that initiating monitoring after 3 sedation days is highly recommended. In addition, patients requiring infusion rates of midazolam above 0.35mg/kg/h should be considered at high risk for IWS.
Keywords benzodiazepine
fentanyl
midazolam
opiate
pediatric intensive care
withdrawal syndrome
xmlui.dri2xhtml.METS-1.0.item-coverage Philadelphia
Language English
Date 2016
Published in Journal Of Addiction Medicine. Philadelphia, v. 10, n. 2, p. 110-116, 2016.
ISSN 1932-0620 (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 110-116
Origin http://dx.doi.org/10.1097/ADM.0000000000000197
Access rights Closed access
Type Article
Web of Science ID WOS:000374748800006
URI https://repositorio.unifesp.br/handle/11600/57831

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