Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Nov 1;51(11):1502-1514.
doi: 10.1097/CCM.0000000000005951. Epub 2023 Jun 7.

International Analgesia and Sedation Weaning and Withdrawal Practices in Critically Ill Adults: The Adult Iatrogenic Withdrawal Study in the ICU

Scott Bolesta  1 , Lisa Burry  2 , Marc M Perreault  3 , Céline Gélinas  4 , Kathryn E Smith  5 , Rebekah Eadie  6 , Federico C Carini  7   8 , Katrianna Saltarelli  9 , Jennifer Mitchell  10 , Jamie Harpel  1 , Ryan Stewart  1 , Richard R Riker  11 , Gilles L Fraser  12 , Brian L Erstad  13 ; AduLt iatrogEnic withdRawal sTudy in the ICU (ALERT-ICU) Study Investigators
Collaborators, Affiliations
Observational Study

International Analgesia and Sedation Weaning and Withdrawal Practices in Critically Ill Adults: The Adult Iatrogenic Withdrawal Study in the ICU

Scott Bolesta et al. Crit Care Med. .

Abstract

Objectives: Iatrogenic withdrawal syndrome (IWS) associated with opioid and sedative use for medical purposes has a reported high prevalence and associated morbidity. This study aimed to determine the prevalence, utilization, and characteristics of opioid and sedative weaning and IWS policies/protocols in the adult ICU population.

Design: International, multicenter, observational, point prevalence study.

Setting: Adult ICUs.

Patients: All patients aged 18 years and older in the ICU on the date of data collection who received parenteral opioids or sedatives in the previous 24 hours.

Interventions: None.

Measurements and main results: ICUs selected 1 day for data collection between June 1 and September 30, 2021. Patient demographic data, opioid and sedative medication use, and weaning and IWS assessment data were collected for the previous 24 hours. The primary outcome was the proportion of patients weaned from opioids and sedatives using an institutional policy/protocol on the data collection day. There were 2,402 patients in 229 ICUs from 11 countries screened for opioid and sedative use; 1,506 (63%) patients received parenteral opioids, and/or sedatives in the previous 24 hours. There were 90 (39%) ICUs with a weaning policy/protocol which was used in 176 (12%) patients, and 23 (10%) ICUs with an IWS policy/protocol which was used in 9 (0.6%) patients. The weaning policy/protocol for 47 (52%) ICUs did not define when to initiate weaning, and the policy/protocol for 24 (27%) ICUs did not specify the degree of weaning. A weaning policy/protocol was used in 34% (176/521) and IWS policy/protocol in 9% (9/97) of patients admitted to an ICU with such a policy/protocol. Among 485 patients eligible for weaning policy/protocol utilization based on duration of opioid/sedative use initiation criterion within individual ICU policies/protocols 176 (36%) had it used, and among 54 patients on opioids and/or sedatives ≥ 72 hours, 9 (17%) had an IWS policy/protocol used by the data collection day.

Conclusions: This international observational study found that a small proportion of ICUs use policies/protocols for opioid and sedative weaning or IWS, and even when these policies/protocols are in place, they are implemented in a small percentage of patients.

Trial registration: ClinicalTrials.gov NCT04422808.

PubMed Disclaimer

Conflict of interest statement

Dr. Burry’s institution receives funding under the award Canadian Institutes of Health Research (CIHR) project grant (no. 159696). Dr. Gélinas’ institution receives funding under the award CIHR project grant (no. 169043), and CIHR project grant (no. 168983), the Fonds de recherche en santé du Québec, and the Nursing Collaborative—Jewish General Hospital; she received funding from the Office of the Federal Publish Defender. Dr. Eadie’s institution receives funding from HSC Public Health Agency Research and Development Division NI. Dr. Saltarelli received funding from Wilkes University Provost Research and Scholarship Grant. Dr. Riker’s institution receives funding under the award number National Institute of General Medical Sciences 1P20GM139745; he and Dr. Fraser serve on the data and safety monitoring board for a sedation study but receive no payment. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

References

    1. Tobias JD: Tolerance, withdrawal, and physical dependency after long-term sedation and analgesia of children in the pediatric intensive care unit. Crit Care Med. 2000; 28:2122–2132
    1. Anand KJS, Willson DF, Berger J, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network: Tolerance and withdrawal from prolonged opioid use in critically III children. Pediatrics. 2010; 125:e1208–e1225
    1. Wang PP, Huang E, Feng X, et al.: Opioid-associated iatrogenic withdrawal in critically ill adult patients: A multicenter prospective observational study. Ann Intensive Care. 2017; 7:88
    1. Brown C, Albrecht R, Pettit H, et al.: Opioid and benzodiazepine withdrawal syndrome in adult burn patients. Am Surg. 2000; 66:367–370; discussion 370-1
    1. Arroyo-Novoa CM, Figueroa-Ramos M, Puntillo K: 1614: Identifying opioid and benzodiazepine withdrawal in trauma intensive care unit (TICU) patients. Crit Care Med. 1614; 2018:791–791

Publication types

Associated data