TY - JOUR
T1 - Withdrawal Assessment Tool-1 Monitoring in PICU
AU - Amigoni, Angela
AU - Mondardini, Maria Cristina
AU - Vittadello, Ilaria
AU - Zaglia, Federico
AU - Rossetti, Emanuele
AU - Vitale, Francesca
AU - Ferrario, Stefania
AU - Savron, Fabio
AU - Coffaro, Giancarlo
AU - Brugnaro, Luca
AU - Amato, Roberta
AU - Wolfler, Andrea
AU - Franck, Linda S.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Objectives: 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. Design: Observational multicenter prospective study. Setting: Eight Italian PICUs belonging to the national PICU network Italian PICU network. Patients: 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. Interventions: Symptoms of withdrawal syndrome were monitored with Withdrawal Assessment Tool-1 scale. Measurements and Main Results: 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. Conclusions: 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.
AB - Objectives: 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. Design: Observational multicenter prospective study. Setting: Eight Italian PICUs belonging to the national PICU network Italian PICU network. Patients: 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. Interventions: Symptoms of withdrawal syndrome were monitored with Withdrawal Assessment Tool-1 scale. Measurements and Main Results: 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. Conclusions: 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.
KW - Analgesia
KW - monitoring
KW - pediatric intensive care unit, abstinence syndrome
KW - sedation
KW - withdrawal syndrome
U2 - 10.1097/PCC.0000000000001054
DO - 10.1097/PCC.0000000000001054
M3 - Article
VL - 18
SP - e86-e91
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
SN - 1529-7535
IS - 2
ER -