title: High doses of benzodiazepine predict analgesic and sedative drug withdrawal syndrome in paediatric intensive care patients.
abstract: OBJECTIVE
  Critically ill children can develop withdrawal syndrome after prolonged analgesia and sedation in a paediatric intensive care unit (PICU), when treatment is stopped abruptly or reduced quickly. The aim of this study was to evaluate the incidence of withdrawal syndrome in patients after three or more days of analgesic or sedative drug therapy, using a validated scale. We also analysed the association between withdrawal syndrome and the patients' outcome and factors related to analgesia and sedation treatment.
  
  
  METHODS
  This prospective observational study analysed 89 periods of weaning from analgesia and sedation in 60 children between October 2010 and October 2011. Of these, 65% were less than six months old and 45% were admitted to the PICU after heart surgery. Withdrawal syndrome was assessed using the Withdrawal Assessment Tool-1 (WAT-1) scale.
  
  
  RESULTS
  The incidence of withdrawal syndrome was 37%, and the only variable that predicted its presence was the highest administered dose of benzodiazepine. The duration of weaning, Sophia Observational Withdrawal Symptom scale score and nurse judgment were also associated with positive WAT-1 scores.
  
  
  CONCLUSIONS
  Withdrawal syndrome should be considered after three or more days of analgesic or sedative treatment. A high dose of benzodiazepine increases the risk of developing withdrawal symptoms.
authors.affiliation: Pediatric Intensive Care Unit, Department of Pediatrics, University-Hospital, Padua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Amigoni
authors.forename: E
authors.initials: E
authors.lastname: Vettore
authors.forename: V
authors.initials: V
authors.lastname: Brugnolaro
authors.forename: L
authors.initials: L
authors.lastname: Brugnaro
authors.forename: D
authors.initials: D
authors.lastname: Gaffo
authors.forename: M
authors.initials: M
authors.lastname: Masola
authors.forename: A
authors.initials: A
authors.lastname: Marzollo
authors.forename: A
authors.initials: A
authors.lastname: Pettenazzo
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000009:adverse effects*; D001569:Benzodiazepines / Q000008:administration & dosage* / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines
keywords: Analgesic drugs; Drug withdrawal symptoms; Paediatric intensive care unit; Sedatives; Substance withdrawal syndrome