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Opioid and benzodiazepine withdrawal symptoms in paediatric intensive care patients

Linda S Franck1, Ita Naughton, Ira Winter

  • 1Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, Level 7 Old Building, London WC1N 3JH, UK. l.franck@ich.ucl.ac.uk

Intensive & Critical Care Nursing
|November 30, 2004
PubMed

Insights

Critically ill children often experience significant opioid and benzodiazepine withdrawal symptoms, even with slow tapering. The Opioid and Benzodiazepine Withdrawal Score (OBWS) tool showed adequate clinical utility for assessing these withdrawal symptoms.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology
  • Neonatology

Background:

  • Prolonged use of opioids and benzodiazepines is common in critically ill children.
  • Iatrogenic withdrawal syndromes can complicate patient care and recovery.
  • Standardized protocols for tapering and assessment are needed.

Purpose of the Study:

  • To describe withdrawal symptom occurrence during slow tapering of opioids and benzodiazepines in critically ill children.
  • To evaluate the predictive validity of the Opioid and Benzodiazepine Withdrawal Score (OBWS) tool.
  • To identify areas for improvement in withdrawal management guidelines.

Main Methods:

  • Prospective, repeated measures study design.
  • Inclusion of 15 critically ill children (6 weeks-28 months) with prolonged opioid/benzodiazepine exposure (≥4 days).
  • Utilized a standardized assessment tool to evaluate withdrawal symptoms during a slow tapering protocol.

Main Results:

  • 13 out of 15 children exhibited moderate to severe withdrawal symptoms.
  • Symptom intensity was not correlated with prior drug exposure, ECMO, or tapering duration.
  • Children receiving fentanyl alongside morphine showed withdrawal more frequently.
  • The OBWS tool demonstrated adequate predictive validity for clinical use.

Conclusions:

  • Significant withdrawal symptoms are prevalent in critically ill children despite standardized tapering.
  • The OBWS tool is clinically useful but requires further refinement.
  • Current clinical guidelines for withdrawal prevention and management need improvement.
  • Further research is essential to optimize iatrogenic withdrawal management in pediatric critical care.

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