Síndrome de abstinencia en Cuidados Intensivos Pediátricos. Incidencia y factores de riesgo

Carrión, F. Fernández; Gáboli, Mirella; González-Celador, Rafael; Quero-Masía, P. Gómez de; Miguel, S. Fernández-de; Murga-Herrera, V.; Serrano-Ayestarán, O.; Sánchez-Granados, J.M.; Payo-Pérez, R.

doi:10.1016/j.medin.2012.02.009

Cited by 31 publications

(19 citation statements)

References 28 publications

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“…36 Positive correlations between duration of benzodiazepine therapy and IWS have been identified in other studies of concurrent opioid and benzodiazepine administration. 1,8,17,30,31 Similar to opioid duration, these correlations are moderate, ranging from r=0.23 ( p <0.01) 8 to r=0.52 ( p <0.001).…”

Section: Resultsmentioning

confidence: 74%

“…1,8,16,17,25–27,30–33,36 Some used statistical methods to establish predictive opioid thresholds, with cut-off lengths of therapy ranging from ≥5 27 to 8 days (OR=18, p = 0.02). 25 Exposures longer than 9 days were 100% predictive of IWS.…”

Section: Resultsmentioning

confidence: 99%

“…1,4,8,12–14,16,17,20,21,23–30,32,35,36,38–40 Description of dosing varied, with the most common measure being cumulative dose (total amount of drug administered during treatment).…”

Section: Resultsmentioning

confidence: 99%

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Risk Factors Associated With Iatrogenic Opioid and Benzodiazepine Withdrawal in Critically Ill Pediatric Patients

Best

Boullata

Curley³

2015

Pediatric Critical Care Medicine

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Objective Analgesia and sedation are common therapies in pediatric critical care, and rapid titration of these medications is associated with iatrogenic withdrawal syndrome (IWS). We performed a systematic review of the literature to identify all common and salient risk factors associated with IWS and build a conceptual model of IWS risk in critically ill pediatric patients. Data sources Multiple databases, including PubMed/Medline, EMBASE, CINAHL, and the Cochrane Central Registry of Clinical Trials were searched using relevant terms from January 1, 1980 to August 1, 2014. Study selection Articles were included if they were published in English and discussed IWS following either opioid or benzodiazepine therapy in children in acute or intensive care settings. Articles were excluded if subjects were neonates born to opioid- or benzodiazepine-dependent mothers, children diagnosed as substance abusers, or subjects with cancer-related pain; if data about opioid or benzodiazepine treatment were not specified; or if primary data were not reported. Data extraction and synthesis In total 1395 papers were evaluated, 33 of which met the inclusion criteria. To facilitate analysis, all opioid and/or benzodiazepine doses were converted to morphine or midazolam equivalents, respectively. A table of evidence was developed for qualitative analysis of common themes, providing a framework for the construction of a conceptual model. The strongest risk factors associated with IWS include duration of therapy and cumulative dose. Additionally, evidence exists linking patient, process and system factors in the development of IWS. Findings Most papers were prospective observational or interventional studies. Conclusions Given the state of existing evidence, well-designed prospective studies are required to better characterize IWS in critically ill pediatric patients. This review provides data to support the construction of a conceptual model of IWS risk that, if supported, could be useful in guiding future research.

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Section: Resultsmentioning

confidence: 74%

Section: Resultsmentioning

confidence: 99%

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Risk Factors Associated With Iatrogenic Opioid and Benzodiazepine Withdrawal in Critically Ill Pediatric Patients

Best

Boullata

Curley³

2015

Pediatric Critical Care Medicine

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“…En 1990 publicó el sistema modificado que está actualmente en uso en la mayoría de las Unidades Neonatales (3,9) . La escala de Finnegan es la herramienta más utilizada para la detección y valoración de la respuesta a las intervenciones terapéuticas en la evolución del SAN, considerando que una puntuación igual o superior a 8 y menor de 12 era compatible con la presencia de SA leve, entre 12 y 16 moderado y más de 16 severo (10) . Si la puntuación es de 8 puntos o mayor, habrá que emprender el método de cuantificación cada dos horas, continuando durante 24 horas como mínimo, si en tres sesiones consecutivas la puntuación es igual o superior a 8 habrá que valorar al recién nacido para emprender farmacoterapia 5,10,11 .…”

Section: Introductionunclassified

“…Los agentes más comúnmente empleados una vez instaurado son el ácido paregórico, solución de morfina preparada a partir del opio, de administración oral con ausencia de efectos secundarios; diazepán vía intramuscular, que debe de ser evitado en prematuros y en niños con ictericia, ya que es metabolizado a nivel hepático; la clorpromazina, que controla los síntomas gastrointestinales y neurológicos en el SAN por narcóticos no opiáceos; el fenobarbital, que actúa fundamentalmente sobre la irritabilidad, aunque no tiene efectos sobre los síntomas gastrointestinales, siendo el tratamiento de elección en la abstinencia de barbitúricos, alcohol y sedantes; y por último la Clonidina, y metadona para el SAN por metadona (10,11) . El conocimiento de la clínica, la valoración de las manifestaciones y los cuidados de enfermería que se prestan a estos neonatos contribuyen de manera importante al bienestar del recién nacido y por tanto a su recuperación (2) .…”

Section: Introductionunclassified

Síndrome de abstinencia neonatal: evolución en los últimos diez años

Pórcel‐Gálvez

Martinez²,

Trigo

et al. 2014

eglobal

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Nº 36 Octubre 2014Página 337 REVISIONES Síndrome de abstinencia neonatal: evolución en los últimos diez añosNeonatal Abstience Syndrome: evolution in the last ten years *Porcel Gálvez, Ana María **Ortega Martínez, Sandra María ***BarrrientosTrigo, Sergio ****Ferrinho Ferreira, Rogerio *Martínez Lara, Concepción RESUMENIntroducción: El Síndrome de abstinencia neonatal se define como un conjunto de síntomas que experimenta el recién nacido tras la retirada de drogas que causan adicción. Actualmente el consumo de sustancias de abuso es uno de los problemas sanitarios más importantes de nuestra sociedad. El consumo de drogas por parte de las mujeres embarazadas es una situación relativamente frecuente e implica graves secuelas para los recién nacidos.Objetivo: Conocer el estado de la prevalencia e incidencia del síndrome de abstinencia neonatal (SAN) recogido en la literatura.Metodología: Se ha llevado a cabo una búsqueda bibliográfica a través de las bases de datos que ofrece la Biblioteca de la Universidad de Sevilla: IME biomedicina, PubMed, SCOPUS, CINAHL, CUIDEN y The Cochrane Library Plus.Resultados: Se han encontrado 627 artículos en total, de los cuales 62 artículos parecían válidos, seleccionando finalmente 22 a los que se han añadido 5 artículos más de una búsqueda secundaria admitiendo en total 27 artículos. Conclusiones:Tras la revisión se ha observado un incremento de la prevalencia en los últimos años respecto al consumo de drogas en mujeres en edad fértil y en mujeres embarazadas, lo que ha repercutido en un aumento del síndrome de abstinencia neonatal. Por lo que sería recomendable la Enfermería GlobalNº 36 Octubre 2014 Página 338realización de ensayos poblacionales, que permitan comprobar con mayor verosimilitud la incidencia del SAN, junto con la prevención y detección de sustancias tóxicas en el embarazo, que podría ser útil para reducir las cifras de casos. ABSTRACTIntroduction: Neonatal abstinence syndromes defined as a group of symptoms experienced by the newborn after the withdrawal of addictive drugs. Currently substance abuses one of the most important health problems in our society. Drug abuse by pregnant women is a relatively common condition and involves serious consequences for newborns.

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Opioid and Benzodiazepine Weaning in Pediatric Patients: Review of Current Literature

Fenn

Plake

2017

Pharmacotherapy

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Pediatric opioid and benzodiazepine withdrawal are avoidable complications of pain and sedation management that is well described in the literature. To prevent withdrawal from occurring, practitioners regularly use a steady decrease of pain and sedation medications, also known as a weaning or tapering schedule. The weaning schedule is highly variable based on clinician preference and is usually dependent on the clinician. The purposes of this review are to evaluate the current literature on the process of opioid and benzodiazepine weaning in pediatric patients and to assess the various standardized protocols used to decrease withdrawal occurrences. We conducted a search of the PubMed, MEDLINE, Cochrane Library, Cumulative Index of Nursing and Allied Health (CINAHL), Academic Search Premier, and PsycInfo databases. Studies were included if they described a wean or taper in pediatric patients aged 18 years or younger. Studies describing neonatal abstinence syndrome were excluded from the review. A total of 97 studies published between 2000 and 2014 were retrieved; of those, 15 studies met the inclusion criteria. Studies were evaluated for selection of withdrawal assessment tool, wean protocol summary, preferred weaning agents, benzodiazepine withdrawal, and wean-at-home regimen. The most common opioid-weaning protocol approaches described a 10-20% dose decrease per day. Benzodiazepine weaning was not regularly standardized or described. The use of a standardized opioid-weaning protocol reduced withdrawal rates compared with nonstandardized weaning plans. Benzodiazepine weaning was inconsistently evaluated and may have affected study outcomes. Identified areas of improvement include the use of newer withdrawal assessment tools validated in the older pediatric population and standardized withdrawal assessment and reporting.

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Síndrome de abstinencia en Cuidados Intensivos Pediátricos. Incidencia y factores de riesgo

Cited by 31 publications

References 28 publications

Risk Factors Associated With Iatrogenic Opioid and Benzodiazepine Withdrawal in Critically Ill Pediatric Patients

Risk Factors Associated With Iatrogenic Opioid and Benzodiazepine Withdrawal in Critically Ill Pediatric Patients

Síndrome de abstinencia neonatal: evolución en los últimos diez años

Opioid and Benzodiazepine Weaning in Pediatric Patients: Review of Current Literature

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