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

Authors

Scott Bolesta, Department of Pharmacy Practice, Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, PA.
Lisa Burry, Departments of Pharmacy and Medicine, Sinai Health System, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.
Marc M. Perreault, Department of Pharmacy, McGill University Health Center and Faculty of Pharmacy, University of Montréal, Montréal, Canada.
Céline Gélinas, Ingram School of Nursing, McGill University, and Centre for Nursing Research/Lady Davis Institute, Jewish General Hospital-CIUSSS West-Central-Montréal, Montréal, Canada.
Kathryn E. Smith, Pharmacy, Maine Medical Center, Portland, ME.
Rebekah Eadie, Critical Care/Pharmacy, Ulster Hospital, Dundonald, United Kingdom.
Federico C. Carini, MS-ICU, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Katrianna Saltarelli, Pharmacy, Baptist Memorial Health Care, Columbus, MS.

Document Type

Article

Publication Date

6-7-2023

Institution/Department

Pharmacy; Critical Care Medicine

Journal Title

Critical care medicine

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.

Recommended Citation

Bolesta S, Burry L, Perreault MM, et al. International Analgesia and Sedation Weaning and Withdrawal Practices in Critically Ill Adults: The Adult Iatrogenic Withdrawal Study in the ICU [published online ahead of print, 2023 Jun 7]. Crit Care Med. 2023;10.1097/CCM.0000000000005951. doi:10.1097/CCM.0000000000005951