International Analgesia and Sedation Weaning and Withdrawal Practices in Critically Ill Adults: The Adult Iatrogenic Withdrawal Study in the ICU.

Objectives: Iatrogenic withdrawal syndrome (IWS) associated with opioid and sedative use for medical purposes has a reported high prevalence and associated morbidity. This study aimed to determine the prevalence, utilization, and characteristics of opioid and sedative weaning and IWS policies/protocols in the adult ICU population.
Design: International, multicenter, observational, point prevalence study.
Setting: Adult ICUs.
Patients: All patients aged 18 years and older in the ICU on the date of data collection who received parenteral opioids or sedatives in the previous 24 hours.
Interventions: None.
Measurements and Main Results: ICUs selected 1 day for data collection between June 1 and September 30, 2021. Patient demographic data, opioid and sedative medication use, and weaning and IWS assessment data were collected for the previous 24 hours. The primary outcome was the proportion of patients weaned from opioids and sedatives using an institutional policy/protocol on the data collection day. There were 2,402 patients in 229 ICUs from 11 countries screened for opioid and sedative use; 1,506 (63%) patients received parenteral opioids, and/or sedatives in the previous 24 hours. There were 90 (39%) ICUs with a weaning policy/protocol which was used in 176 (12%) patients, and 23 (10%) ICUs with an IWS policy/protocol which was used in 9 (0.6%) patients. The weaning policy/protocol for 47 (52%) ICUs did not define when to initiate weaning, and the policy/protocol for 24 (27%) ICUs did not specify the degree of weaning. A weaning policy/protocol was used in 34% (176/521) and IWS policy/protocol in 9% (9/97) of patients admitted to an ICU with such a policy/protocol. Among 485 patients eligible for weaning policy/protocol utilization based on duration of opioid/sedative use initiation criterion within individual ICU policies/protocols 176 (36%) had it used, and among 54 patients on opioids and/or sedatives ≥ 72 hours, 9 (17%) had an IWS policy/protocol used by the data collection day.
Conclusions: This international observational study found that a small proportion of ICUs use policies/protocols for opioid and sedative weaning or IWS, and even when these policies/protocols are in place, they are implemented in a small percentage of patients.
Competing Interests: Dr. Burry’s institution receives funding under the award Canadian Institutes of Health Research (CIHR) project grant (no. 159696). Dr. Gélinas’ institution receives funding under the award CIHR project grant (no. 169043), and CIHR project grant (no. 168983), the Fonds de recherche en santé du Québec, and the Nursing Collaborative—Jewish General Hospital; she received funding from the Office of the Federal Publish Defender. Dr. Eadie’s institution receives funding from HSC Public Health Agency Research and Development Division NI. Dr. Saltarelli received funding from Wilkes University Provost Research and Scholarship Grant. Dr. Riker’s institution receives funding under the award number National Institute of General Medical Sciences 1P20GM139745; he and Dr. Fraser serve on the data and safety monitoring board for a sedation study but receive no payment. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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