Opioid, sedative, preadmission medication and iatrogenic withdrawal risk in UK adult critically ill patients: a point prevalence study
Opioid, sedative, preadmission medication and iatrogenic withdrawal risk in UK adult critically ill patients: a point prevalence study
Background: Iatrogenic withdrawal syndrome, after exposure medication known to cause withdrawal is recognised, yet under described in adult intensive care.
Aim: to investigate, opioid, sedation, and preadmission medication practice in critically ill adults with focus on aspects associated with iatrogenic withdrawal syndrome.
Method: one-day point prevalence study in UK intensive care units (ICUs). We collected ICU admission medication and/or substances with withdrawal potential, sedation policy, opioid and sedative use, dose, and duration.
Results: thirty-seven from 39 participating ICUs contributed data from 386 patients. The prevalence rate for parenteral opioid and sedative medication was 56.1% (212 patients). Twenty-three 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. Two hundred and two (95.3%) patients received opioids: 167 (82.7%) by continuous infusions and 90 (44.6%) patients for longer than 96-h. One hundred and sixty-three (76.9%) patients received sedatives: 157 (77.7%) by continuous infusions and 74 (45.4%) patients for longer than 96-h.
Conclusion: opioid sedative and admission medication with iatrogenic withdrawal syndrome potential 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-h placing them at high risk of iatrogenic withdrawal. No participating unit reported using a validated tool for iatrogenic withdrawal assessment.
Analgesics, Cross-sectional study, Opioids critical care, Sedatives
1167-1175
Eadie, Rebekah
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McKenzie, Cathrine A.
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Hadfield, Daniel
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Kalk, Nicola J.
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Bolesta, Scott
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Dempster, Martin
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McAuley, Daniel F.
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Blackwood, Bronagh
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October 2023
Eadie, Rebekah
811a6878-5858-4471-bdfc-ab58cfa6267e
McKenzie, Cathrine A.
ec344dee-5777-49c5-970e-6326e82c9f8c
Hadfield, Daniel
1e82cd3f-00ab-4bf7-9937-5950dddda664
Kalk, Nicola J.
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Bolesta, Scott
d2ac4abc-b895-4c93-bf88-6e5d568ea3fd
Dempster, Martin
ec0841e7-0abc-4590-ac36-a03eafe468ba
McAuley, Daniel F.
03fd8aff-b05b-4bd6-8f4c-952f598095c1
Blackwood, Bronagh
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Eadie, Rebekah, McKenzie, Cathrine A., Hadfield, Daniel, Kalk, Nicola J., Bolesta, Scott, Dempster, Martin, McAuley, Daniel F. and Blackwood, Bronagh
(2023)
Opioid, sedative, preadmission medication and iatrogenic withdrawal risk in UK adult critically ill patients: a point prevalence study.
International journal of clinical pharmacy, 45 (5), .
(doi:10.1007/s11096-023-01614-9).
Abstract
Background: Iatrogenic withdrawal syndrome, after exposure medication known to cause withdrawal is recognised, yet under described in adult intensive care.
Aim: to investigate, opioid, sedation, and preadmission medication practice in critically ill adults with focus on aspects associated with iatrogenic withdrawal syndrome.
Method: one-day point prevalence study in UK intensive care units (ICUs). We collected ICU admission medication and/or substances with withdrawal potential, sedation policy, opioid and sedative use, dose, and duration.
Results: thirty-seven from 39 participating ICUs contributed data from 386 patients. The prevalence rate for parenteral opioid and sedative medication was 56.1% (212 patients). Twenty-three 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. Two hundred and two (95.3%) patients received opioids: 167 (82.7%) by continuous infusions and 90 (44.6%) patients for longer than 96-h. One hundred and sixty-three (76.9%) patients received sedatives: 157 (77.7%) by continuous infusions and 74 (45.4%) patients for longer than 96-h.
Conclusion: opioid sedative and admission medication with iatrogenic withdrawal syndrome potential 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-h placing them at high risk of iatrogenic withdrawal. No participating unit reported using a validated tool for iatrogenic withdrawal assessment.
Text
ALERTICU paper 23.3 IJCP_RE tables updated 29.5 BB[2]
- Accepted Manuscript
Text
s11096-023-01614-9
- Version of Record
More information
Accepted/In Press date: 7 June 2023
e-pub ahead of print date: 15 July 2023
Published date: October 2023
Additional Information:
Funding Information:
The authors would like to thank the United Kingdom Clinical Pharmacy Association (UKCPA) Critical Care Pharmacy Group for their support in delivering this project and all contributors for providing their data (Supplementary file 2. Name of investigators)
Funding Information:
Rebekah Eadie received funding from Health and Social Care (HSC) Research and Development Bridging Scheme-Predoctoral Support HSC Public Health Agency, Northern Ireland (Ref EAT/5665/21). Dr Cathrine A McKenzie receives funding from the National Institute for Health and Care Research (NIHR) Applied Research Collaborative (ARC) Wessex. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care.
Publisher Copyright:
© 2023, The Author(s).
Keywords:
Analgesics, Cross-sectional study, Opioids critical care, Sedatives
Identifiers
Local EPrints ID: 479803
URI: http://eprints.soton.ac.uk/id/eprint/479803
ISSN: 2210-7703
PURE UUID: f5cd31b2-2d56-4c17-adde-e6d5263b56a6
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Date deposited: 26 Jul 2023 17:09
Last modified: 17 Mar 2024 04:23
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Contributors
Author:
Rebekah Eadie
Author:
Cathrine A. McKenzie
Author:
Daniel Hadfield
Author:
Nicola J. Kalk
Author:
Scott Bolesta
Author:
Martin Dempster
Author:
Daniel F. McAuley
Author:
Bronagh Blackwood
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