ABSTRACT 296

Abstract

Background and aims: Iatrogenic withdrawal syndrome (IWS) – physiologic symptoms that manifest following rapid weaning or abrupt cessation of opioids or benzodiazepines in drug tolerant patients – is prevalent in critically ill children receiving >5 days of sedation. Aims: The purpose of this study was to develop a conceptual model of risk factors contributing to the development of IWS, to provide a theoretical basis for future research. Methods: A systematic review of the literature (1 January 1980 to 10 December 2013) was conducted, using PubMed, EMBASE, CINAHL, and the Cochrane Registry of Clinical Trials. Search terms included “respiration, artificial,” “weaning,” and “analgesics, opioid” and “benzodiazepines.” Data were extracted into pre-determined tables and qualitatively synthesized. Results: Current literature suggests three categories of risk factors associated with IWS in critically ill children: patient-, process- and system-level factors. Risk factors specific to the patient include age, disease severity, and cumulative dose of sedative medication. Use of validated assessment tools, standardized weaning protocols, and prescription of multiple adjunctive agents are process-level factors. Finally, sedation therapy occurs within a system context, which determines factors such as protocol compliance. However, further work is needed to elucidate the contributions of system-level factors to overall risk of IWS.FigureConclusions: The proposed conceptual model illustrates the convergence of patient-, process-, and system-level factors with physiologic tolerance in determining a patient’s risk for IWS.