Acute withdrawal syndrome related to the administration of analgesic and sedative medications in adult intensive care unit patients

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Abstract

Objectives

To estimate the frequency of acute withdrawal syndrome related to the administration of analgesic and sedative medications in mechanically ventilated adult intensive care unit (ICU) patients; to identify associated clinical factors.

Design

Retrospective review of medical records.

Setting

An adult trauma/surgical ICU in an urban Level I trauma center.

Patients

Twenty-eight mechanically ventilated adult trauma/surgical ICU patients requiring >7 days of ICU care.

Interventions

None.

Measurements and Main Results

Daily doses of all opioid, sedative, hypnotic, and major tranquilizer drugs administered to each patient were measured, as was duration of ICU stay, duration of mechanical ventilation, and duration of the administration of analgesic, sedative, and neuromuscular blocking agents (NMBAs) for each patient. All opioids and benzodiazepines were converted to their respective fentanyl and lorazepam equivalent units based on potency and bioavailability. Calculation of the weaning rate for each patient during tapering from opioid and benzodiazepine medications was performed. The presence or absence of acute withdrawal syndrome was identified for each patient.

Conclusions

These results suggest that mechanically ventilated adult patients with extended ICU care (>or=to7 days) who receive large doses of analgesic and sedative medications are at risk for acute withdrawal syndromes during drug weaning. The association between ARDS and withdrawal syndrome, combined with the observation that withdrawal syndromes were also associated with the use of neuromuscular blocking agents and prolonged mechanical ventilation, suggests that patients with ARDS may be more likely to receive high doses of analgesic and sedative medications, and are therefore at increased risk for withdrawal syndrome. (Crit Care Med 1998; 26:676-684)

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