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

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dc.citation.issue2
dc.citation.volume10
dc.contributor.authorLucas da Silva, Paulo Sergio
dc.contributor.authorReis, Maria Eunice
dc.contributor.authorMachado Fonseca, Thais Suelotto
dc.contributor.authorMachado Fonseca, Marcelo Cunio [UNIFESP]
dc.coveragePhiladelphia
dc.date.accessioned2020-08-21T17:00:00Z
dc.date.available2020-08-21T17:00:00Z
dc.date.issued2016
dc.description.abstractBackground 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.en
dc.description.affiliationHosp Servidor Publ Municipal, Dept Pediat, Pediat Intens Care Unit, Rua Castro Alves 60, BR-01532900 Sao Paulo, Brazil
dc.description.affiliationHosp & Maternidade Santa Joana, Sao Paulo, Brazil
dc.description.affiliationFac Med ABC, Santo Andre, Brazil
dc.description.affiliationUniv Fed Sao Paulo, Hlth Technol Assessment Ctr, Sao Paulo, Brazil
dc.description.affiliationUnifespUniv Fed Sao Paulo, Hlth Technol Assessment Ctr, Sao Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent110-116
dc.identifierhttp://dx.doi.org/10.1097/ADM.0000000000000197
dc.identifier.citationJournal Of Addiction Medicine. Philadelphia, v. 10, n. 2, p. 110-116, 2016.
dc.identifier.doi10.1097/ADM.0000000000000197
dc.identifier.issn1932-0620
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/57831
dc.identifier.wosWOS:000374748800006
dc.language.isoeng
dc.publisherLippincott Williams & Wilkins
dc.relation.ispartofJournal Of Addiction Medicine
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectbenzodiazepineen
dc.subjectfentanylen
dc.subjectmidazolamen
dc.subjectopiateen
dc.subjectpediatric intensive careen
dc.subjectwithdrawal syndromeen
dc.titleOpioid and Benzodiazepine Withdrawal Syndrome in PICU Patients: Which Risk Factors Matter?en
dc.typeinfo:eu-repo/semantics/article
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