Response.

Abstract

The points raised by Dr Pektezel and collaborators are interesting and would indeed complement our pilot study. In our entry criteria, we were looking for patients who were exposed to opioids to a degree sufficient to be at risk of iatrogenic withdrawal. In this era of intensive care unit (ICU) liberation whereby analgesia is optimized, sedation is minimized, and a ventilator weaning protocol is implemented, the population most at risk of iatrogenic withdrawal in our 2 units was the trauma population. A significant portion of our patients had polytrauma and some had combined polytrauma and mild traumatic brain injury (TBI). Unfortunately, only 1 patient in our study was admitted with a nervous system disorder, representing 12% of our 8 patients who had iatrogenic withdrawal syndrome develop.1,2 No conclusion can be drawn from that sole patient.We fully agree with Dr Pektezel and collaborators that pathophysiologically, organic cerebral involvement could falsely affect the results of the Withdrawal Assessment Tool-1 (WAT-1). For this given reason, we had chosen to exclude patients with moderate and severe TBI. It remains to be determined how much mild TBI influences the validity of the WAT-1 assessment. Clearly this syndrome needs further study in a variety of critically ill adults, and the trauma population is definitely one that is at significant risk. Results of our pilot study point to a cautious approach in using the WAT-1 scale in critically ill adults. Currently, the available data are limited, and thus we are pleased that our results have raised interest in this often-unrecognized syndrome.On behalf of all authors of the original article,1