Withdrawal Assessment Tool-1 Monitoring in PICU: A Multicenter Study on Iatrogenic Withdrawal Syndrome.
Withdrawal syndrome is an adverse reaction of analgesic and sedative therapy, with a reported occurrence rate between 17% and 57% in critically ill children. Although some factors related to the development of withdrawal syndrome have been identified, there is weak evidence for the effectiveness of preventive and therapeutic strategies. The main aim of this study was to evaluate the frequency of withdrawal syndrome in Italian PICUs, using a validated instrument. We also analyzed differences in patient characteristics, analgesic and sedative treatment, and patients' outcome between patients with and without withdrawal syndrome.



Observational multicenter prospective study.



Eight Italian PICUs belonging to the national PICU network Italian PICU network.



One hundred thirteen patients, less than 18 years old, mechanically ventilated and treated with analgesic and sedative therapy for five or more days. They were admitted in PICU from November 2012 to May 2014.



Symptoms of withdrawal syndrome were monitored with Withdrawal Assessment Tool-1 scale.



The occurrence rate of withdrawal syndrome was 64.6%. The following variables were significantly different between the patients who developed withdrawal syndrome and those who did not: type, duration, and cumulative dose of analgesic therapy; duration and cumulative dose of sedative therapy; clinical team judgment about analgesia and sedation's difficulty; and duration of analgesic weaning, mechanical ventilation, and PICU stay. Multivariate logistic regression analysis revealed that patients receiving morphine as their primary analgesic were 83% less likely to develop withdrawal syndrome than those receiving fentanyl or remifentanil.



Withdrawal syndrome was frequent in PICU patients, and patients with withdrawal syndrome had prolonged hospital treatment. We suggest adopting the lowest effective dose of analgesic and sedative drugs and frequent reevaluation of the need for continued use. Further studies are necessary to define common preventive and therapeutic strategies.
1PICU University-Hospital, Padova, Italy. 2PICU University-Hospital, S.Orsola-Malpighi, Bologna, Italy. 3PICU University-Hospital, Verona, Italy. 4PICU Paediatric Hospital Bambino Gesù, Roma, Italy. 5Department of Anesthesia and Intensive Care, Pediatric ICU and Pediatric Trauma Center, Catholic University of Rome, Rome, Italy. 6PICU Paediatric Hospital Buzzi-Milano, Milano, Italy. 7PICU IRCCS Burlo Garofolo-Trieste, Trieste, Italy. 8PICU ARNAS Hospital Benfratelli, Di Cristina-Palermo, Palermo, Italy. 9Department of Education and Training, University-Hospital, Padova, Italy. 10CINECA, Consortium Interuniversity, Bologna, Italy. 11School of Nursing, University of California, San Francisco, CA.
Angela
A
Amigoni
Maria Cristina
MC
Mondardini
Ilaria
I
Vittadello
Federico
F
Zaglia
Emanuele
E
Rossetti
Francesca
F
Vitale
Stefania
S
Ferrario
Fabio
F
Savron
Giancarlo
G
Coffaro
Luca
L
Brugnaro
Roberta
R
Amato
Andrea
A
Wolfler
Linda S
LS
Franck
D000293:Adolescent; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D007049:Iatrogenic Disease / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology
D000700:Analgesics; D006993:Hypnotics and Sedatives