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Patient, Process, and System Predictors of Iatrogenic Withdrawal Syndrome in Critically Ill Children

Kaitlin M Best1, David Wypij, Lisa A Asaro

  • 11Hillman Scholar in Nursing Innovation, University of Pennsylvania School of Nursing, Nurse Resident, The Children's Hospital of Philadelphia, Philadelphia, PA. 2Department of Cardiology, Boston Children's Hospital, Boston, MA. 3Department of Pediatrics, Harvard Medical School, Boston, MA. 4Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA. 5Ellen and Robert Kapito Professor in Nursing Science, School of Nursing, Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

Critical Care Medicine
|August 12, 2016
PubMed

Insights

Iatrogenic withdrawal syndrome is common in critically ill children. Risk factors include younger age, cognitive impairment, higher sedative doses, longer sedation duration, and increased nursing workload.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology
  • Health Systems Research

Background:

  • Iatrogenic withdrawal syndrome (IWS) is a significant concern in critically ill children requiring prolonged mechanical ventilation and sedation.
  • Understanding predictive risk factors is crucial for developing targeted prevention strategies.

Purpose of the Study:

  • To develop a multidimensional predictive model for identifying children at risk of developing iatrogenic withdrawal syndrome.
  • To analyze patient, process, and healthcare system factors associated with IWS in pediatric intensive care unit (PICU) patients.

Main Methods:

  • Secondary analysis of prospective data from the Randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial.
  • Logistic regression with generalized estimating equations was used to identify risk factors for IWS in 1,157 children.
  • IWS was defined by specific scores on the Withdrawal Assessment Tool-Version 1 during opioid weaning.

Main Results:

  • Nearly half of the children (47%) developed IWS.
  • Significant predictors included younger age, preexisting cognitive impairment, higher opioid doses, longer sedation duration, multiple sedative classes, increased nursing workload, and one-to-one nurse staffing.
  • Children with IWS were younger and had more pre-existing conditions.

Conclusions:

  • Iatrogenic withdrawal syndrome is prevalent in critically ill children and influenced by patient, sedative exposure, and system-level factors.
  • Identifying high-risk patients prior to weaning can facilitate proactive prevention of IWS.
  • The findings support the need for comprehensive risk assessment and tailored interventions.
Abstract

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