Opioid, sedative, pre-admission medication and iatrogenic withdrawal risk in UK adult critically ill patients: a point prevalence study

Abstract

Background: iatrogenic withdrawal syndrome, after exposure medication known to cause withdrawal is recognised, yet under described in adult intensive care.

Aim: investigate, opioid, sedation and preadmission medication practice in critically ill adults with focus on aspects associated with iatrogenic withdrawal syndrome

Methods: one-day point prevalence study in UK ICUs. We collected ICU admission medication and/or substances with withdrawal potential, sedation policy, opioid and sedative use, dose, and duration.

Results: 37 from 39 participating ICUs contributed data from 386 patients. The prevalence rate for parenteral opioid and sedative medication was 56.1%, (212 patients). 23 ICUs (59%) had no sedation/analgesia policy, and no ICUs screened for iatrogenic withdrawal. Patient admission medications with withdrawal-potential included antidepressants or antipsychotics (43, 20.3%) and nicotine (41, 19.3%). Of 212 patients, 202 (95.3%) received opioids, 163 (76.9%) sedatives and 153 (72.2%) both. 202 (95.3%) patients received opioids: 167 (82.7%) by continuous infusions and 90 (44.6%) patients for longer than 96-hours. 163 (76.9%) patients received sedatives: 157 (77.7%) by continuous infusions and 74 (45.4%) patients for longer than 96-hours.

Conclusion: opioid and sedative prevalence rates were high, and a high proportion of ICUs had no sedative/analgesic policies. Nearly half of patients received continuous opioids and sedatives for longer than 96-hours placing them at high risk of iatrogenic withdrawal. No participating unit reported using a validated tool for iatrogenic withdrawal assessment.

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Identifiers

ORCID for Cathrine Anne McKenzie: orcid.org/0000-0002-5190-9711

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