Patterns of opioid and sedative use in adult ICUs: Insights from the ALERT-ICU study on iatrogenic withdrawal syndrome

Document Type

Article

Publication Date

1-23-2026

Institution/Department

Center for Clinical & Translational Science; Critical Care

Journal Title

Journal of critical care

Abstract

BACKGROUND: Iatrogenic withdrawal syndrome (IWS) can develop due to prolonged use of opioids and sedatives. This study aimed to evaluate the current usage patterns of these medications in adult ICUs and their potential link to IWS risk, hypothesizing that cumulative doses would increase with longer ICU stays. METHODS: This international, multicenter, observational, point-prevalence study included all patients aged 18 and older in adult ICUs who received parenteral opioids or sedatives in the previous 24 h. Data were collected on a selected day between June 1 and September 30, 2021, focusing on medication use over the preceding 24 h. The main outcome measure was the proportion of patients receiving regularly dosed parenteral opioids or sedatives for ≥72 h. RESULTS: A total of 1506 patients from 229 ICUs across 87 hospitals in 11 countries were analyzed. Among those on opioids or sedatives for ≥72 h, 52.4% received regularly dosed opioids, and 56.4% received sedatives. Continuous IV infusion was observed in 63.6% for opioids and 59.1% for sedatives. Median 24-h total doses were significantly higher in patients on opioids-sedatives for ≥72 h (p <  0.030). Additionally, significantly more patients on < 72 h received >50% dose reductions (61% vs. 38%; p <  0.001) and initiated enteral medication (24% vs. 15%; p <  0.001). CONCLUSION: Over half of adult ICU patients are administered regularly dosed parenteral opioids-sedatives for ≥72 h, often at higher doses, potentially increasing the risk of IWS.

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155444

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