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Opioid tapering and weaning protocols in pediatric critical care units: a systematic review

Pedro Bichaff1, Karina T Setani1, Emiliana H G Motta1

  • 1Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo (SP), Brasil.

Revista Da Associacao Medica Brasileira (1992)
|December 6, 2018
PubMed

Insights

Opioid abstinence syndrome in children can be managed with methadone. This review explores initial dosing, tapering, and assessment tools to improve care for pediatric patients undergoing opioid withdrawal.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology
  • Evidence-Based Practice

Background:

  • Opioid abstinence syndrome is prevalent in pediatric intensive care units (PICUs) due to necessary sedation.
  • Current management lacks specific guidelines, highlighting a need for standardized approaches.
  • Methadone is increasingly utilized for preventing opioid withdrawal symptoms during weaning.

Purpose of the Study:

  • To systematically review existing research on managing opioid abstinence syndrome in pediatric critical care.
  • To establish evidence-based recommendations for initial methadone dosage, tapering rates, and assessment tools.
  • To guide prompt recognition and intervention for opioid withdrawal in critically ill children.

Main Methods:

  • A systematic review of 49 observational and experimental studies from four databases.
  • Inclusion criteria focused on pediatric patients in acute opioid use within critical care settings.
  • Data extraction centered on initial methadone dose, clinical protocols, and abstinence assessment tools.

Main Results:

  • Significant heterogeneity exists in methadone dosing calculations across studies.
  • Pre-defined opioid tapering protocols were associated with reduced abstinence incidence.
  • The Withdrawal Assessment Tool-1 demonstrated good sensitivity and specificity for identifying opioid withdrawal.

Conclusions:

  • Limited evidence exists for adjuvant medications in preventing opioid abstinence syndrome.
  • This review aims to enhance clinical practices for opioid weaning in pediatric intensive care.
  • Further research is needed to refine management strategies and support evidence-based guidelines.
Abstract

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