Faculty Collaboration Database

Patient, Process, and System Predictors of Iatrogenic Withdrawal Syndrome in Critically Ill Children. Crit Care Med 2017 Jan;45(1):e7-e15

Date

08/12/2016

Pubmed ID

27513532

DOI

10.1097/CCM.0000000000001953

Scopus ID

2-s2.0-85006421928 (requires institutional sign-in at Scopus site)   49 Citations

Abstract

OBJECTIVE: To generate a multidimensional predictive model of risk factors for iatrogenic withdrawal syndrome in critically ill children.

DESIGN: Secondary analysis of prospective data from the Randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial.

SETTING: PICU.

PATIENTS: Children who received greater than or equal to 5 days of sedation during mechanical ventilation for acute respiratory failure.

INTERVENTIONS: The Randomized Evaluation of Sedation Titration for Respiratory Failure study tested the effect of a nurse-led, goal-directed sedation protocol on clinical outcomes. There was no additional intervention in this secondary analysis.

MEASUREMENTS AND MAIN RESULTS: Data included 1,157 children from 31 PICUs. Iatrogenic withdrawal syndrome was defined as having at least two Withdrawal Assessment Tool-Version 1 scores greater than or equal to 3 after the start of opioid weaning. Logistic regression with generalized estimating equations to account for clustering by site was used to evaluate patient, process, and healthcare system risk factors for iatrogenic withdrawal syndrome. Subjects with iatrogenic withdrawal syndrome (544/1,157; 47%) were younger and more likely to have preexisting cognitive or functional impairment. They also received higher sedative doses and longer exposure periods. In multivariable analyses, significant predictors of iatrogenic withdrawal syndrome included younger age, preexisting cognitive impairment, higher preweaning mean daily opioid dose, longer duration of sedation, receipt of three or more preweaning sedative classes, higher nursing workload, and more one-to-one nurse staffing.

CONCLUSIONS: Iatrogenic withdrawal syndrome is common in children recovering from critical illness, and several risk factors are predictive, including patient characteristics, sedative exposure, additional sedative agents, and system-level factors. High-risk patients could be identified before weaning to better prevent iatrogenic withdrawal syndrome among at-risk patients.

Author List

Best KM, Wypij D, Asaro LA, Curley MA, Randomized Evaluation of Sedation Titration For Respiratory Failure Study Investigators

Author

Rainer G. Gedeit MD Associate Chief Medical Officer in the Children's Administration department at Children's Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Age Factors
Analgesics, Opioid
Child
Child, Preschool
Cognition Disorders
Critical Care
Critical Illness
Dose-Response Relationship, Drug
Drug Tolerance
Female
Humans
Iatrogenic Disease
Infant
Intensive Care Units, Pediatric
Male
Nursing Staff, Hospital
Personnel Staffing and Scheduling
Prospective Studies
Respiration, Artificial
Respiratory Insufficiency
Risk Factors
Substance Withdrawal Syndrome
United States
Workload