ACUTE WITHDRAWAL SYNDROME-RELATED TO THE ADMINISTRATION OF ANALGESIC AND SEDATIVE MEDICATIONS IN ADULT INTENSIVE-CARE UNIT PATIENTS

Objectives: To estimate the frequency of acute withdrawal syndrome rel ated to the administration of analgesic and sedative medications in me chanically ventilated adult intensive cave unit (ICU) patients; to ide ntify associated clinical factors. Design: Retrospective review of med ical 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. Intervent ions: 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 slay, duration of mechan ical ventilation, and duration of the administration of analgesic, sed ative, and neuromuscular blocking agents (NMBAs) for each patient. All opioids and benzodiazepines were converted to their respective fentan yl and lorazepam equivalent units based on potency and bioavailability . Calculation of the weaning rate for each patient during tapering fro m opioid and benzodiazepine medications was performed. The presence or absence of acute withdrawal syndrome was identified for each patient. Nine (32.1%) patients developed acute withdrawal syndrome potentially related to the administration of analgesic or sedative medications. P atients in the withdrawal group received significantly higher mean dai ly (p =.049) and peak (p =.032) doses of fentanyl equivalents, as well as higher mean daily lorazepam equivalents (p =.049) compared with pa tients not experiencing withdrawal. Patients in the withdrawal group w ere also significantly more likely to have received neuromuscular bloc king agents (p=.004) or propofol (P =.026) for >1 day during ICU admis sion compared with patients not experiencing withdrawal. Duration of m echanical ventilation (p =.049), benzodiazepine therapy (p =.048), and propofol therapy (p =.049) was also significantly longer in the group experiencing withdrawal. Withdrawal patients received a significantly lower mean daily dose of haloperidol (p =.026). There was a significa nt association between the development of withdrawal syndrome and the presence of ARDS (p =.017). Finally, the slopes of the lines represent ing opioid and benzodiazepine drug weaning were more steep for the wit hdrawal group, although these results did not achieve statistical sign ificance. Conclusions: These results suggest that mechanically ventila ted adult patients with extended ICU care (greater than or equal to 7 days) who receive large doses of analgesic and sedative medications ar e at risk for acute withdrawal syndromes during drug weaning. The asso ciation between ARDS and withdrawal syndrome, combined with the observ ation that withdrawal syndromes were also associated with the use of n euromuscular blocking agents and prolonged mechanical ventilation, sug gests that patients with ARDS may be more likely to receive high doses of analgesic and sedative medications, and are therefore at increased risk far withdrawal syndrome.