TY - JOUR
KW - Analgesics, Opioid/adverse effects
KW - Critical Illness
KW - Humans
KW - Iatrogenic Disease/epidemiology
KW - Intensive Care Units
KW - Opioid-Related Disorders/diagnosis/drug therapy/epidemiology
KW - Risk Factors
KW - Substance Withdrawal Syndrome/diagnosis/drug therapy/epidemiology
KW - assessment tool
KW - critical care
KW - iatrogenic disease
KW - Opioid
KW - Withdrawal symptoms
AU - A. W. Chiu
AU - S. Contreras
AU - S. Mehta
AU - J. Korman
AU - M. M. Perreault
AU - D. R. Williamson
AU - L. D. Burry
A1 - 
AB - OBJECTIVE: To (1) provide an overview of the epidemiology, clinical presentation, and risk factors of iatrogenic opioid withdrawal in critically ill patients and (2) conduct a literature review of assessment and management of iatrogenic opioid withdrawal in critically ill patients. DATA SOURCES: We searched MEDLINE (1946-June 2017), EMBASE (1974-June 2017), and CINAHL (1982-June 2017) with the terms opioid withdrawal, opioid, opiate, critical care, critically ill, assessment tool, scale, taper, weaning, and management. Reference list of identified literature was searched for additional references as well as www.clinicaltrials.gov . STUDY SELECTION AND DATA EXTRACTION: We restricted articles to those in English and dealing with humans. DATA SYNTHESIS: We identified 2 validated pediatric critically ill opioid withdrawal assessment tools: (1) Withdrawal Assessment Tool-Version 1 (WAT-1) and (2) Sophia Observation Withdrawal Symptoms Scale (SOS). Neither tool differentiated between opioid and benzodiazepine withdrawal. WAT-1 was evaluated in critically ill adults but not found to be valid. No other adult tool was identified. For management, we identified 5 randomized controlled trials, 2 prospective studies, and 2 systematic reviews. Most studies were small and only 2 studies utilized a validated assessment tool. Enteral methadone, alpha-2 agonists, and protocolized weaning were studied. CONCLUSION: We identified 2 validated assessment tools for pediatric intensive care unit patients; no valid tool for adults. Management strategies tested in small trials included methadone, alpha-2 agonists, and protocolized sedation/weaning. We challenge researchers to create validated tools assessing specifically for opioid withdrawal in critically ill children and adults to direct management.
AD - 1 Peace Arch Hospital, Fraser Health Authority, White Rock, British Columbia, Canada.; 2 Hospital Universitari de Bellvitge, L'Hospitalet de Llobretat, Barcelona, Spain.; 3 Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada.; 3 Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada.; 4 The Montreal General Hospital-McGill University Health Center, Montreal, Quebec, Canada.; 5 Universite de Montreal, Montreal, Quebec, Canada.; 6 Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada.; 3 Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada.; 7 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
BT - The Annals of Pharmacotherapy
C5 - Measures; Opioids & Substance Use
CP - 12
CY - United States
DO - 10.1177/1060028017724538
IS - 12
JF - The Annals of Pharmacotherapy
M1 - Journal Article
N2 - OBJECTIVE: To (1) provide an overview of the epidemiology, clinical presentation, and risk factors of iatrogenic opioid withdrawal in critically ill patients and (2) conduct a literature review of assessment and management of iatrogenic opioid withdrawal in critically ill patients. DATA SOURCES: We searched MEDLINE (1946-June 2017), EMBASE (1974-June 2017), and CINAHL (1982-June 2017) with the terms opioid withdrawal, opioid, opiate, critical care, critically ill, assessment tool, scale, taper, weaning, and management. Reference list of identified literature was searched for additional references as well as www.clinicaltrials.gov . STUDY SELECTION AND DATA EXTRACTION: We restricted articles to those in English and dealing with humans. DATA SYNTHESIS: We identified 2 validated pediatric critically ill opioid withdrawal assessment tools: (1) Withdrawal Assessment Tool-Version 1 (WAT-1) and (2) Sophia Observation Withdrawal Symptoms Scale (SOS). Neither tool differentiated between opioid and benzodiazepine withdrawal. WAT-1 was evaluated in critically ill adults but not found to be valid. No other adult tool was identified. For management, we identified 5 randomized controlled trials, 2 prospective studies, and 2 systematic reviews. Most studies were small and only 2 studies utilized a validated assessment tool. Enteral methadone, alpha-2 agonists, and protocolized weaning were studied. CONCLUSION: We identified 2 validated assessment tools for pediatric intensive care unit patients; no valid tool for adults. Management strategies tested in small trials included methadone, alpha-2 agonists, and protocolized sedation/weaning. We challenge researchers to create validated tools assessing specifically for opioid withdrawal in critically ill children and adults to direct management.
PP - United States
PY - 2017
SN - 1542-6270; 1060-0280
SP - 1099
EP - 1111
EP - 
T1 - Iatrogenic Opioid Withdrawal in Critically Ill Patients: A Review of Assessment Tools and Management
T2 - The Annals of Pharmacotherapy
TI - Iatrogenic Opioid Withdrawal in Critically Ill Patients: A Review of Assessment Tools and Management
U1 - Measures; Opioids & Substance Use
U2 - 28793780
U3 - 10.1177/1060028017724538
VL - 51
VO - 1542-6270; 1060-0280
Y1 - 2017
Y2 - Dec
ER -