Pediatric Withdrawal Identification and Management

Whelan, Katherine; Heckmann, Maura K.; Lincoln, Patricia; Hamilton, Susan

doi:10.1055/s-0035-1556749

Cited by 7 publications

(8 citation statements)

References 25 publications

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“…While hypoxemia is a potential cause for the neurologic signs in these cases, it is less likely based on the lack of other neurologic deficits to support a diagnosis of hypoxic brain injury. Additionally, while these dogs received multiple sedatives, withdrawal of these drugs, including opioids and alpha antagonists, is associated with signs such as tremors and agitation but has not been associated with seizures, making benzodiazepine withdrawal the most likely scenario in all 3 cases 21 . Due to the temporary lateralizing neurologic deficits in case 1, it is possible that the cause of this dog's seizures was multifactorial including the combination of a forebrain lesion and acute benzodiazepine withdrawal.…”

Section: Discussionmentioning

confidence: 99%

Suspected benzodiazepine withdrawal‐associated seizures in 3 young dogs undergoing mechanical ventilation

Walton

Enders

2022

J Vet Emergen Crit Care

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Objective: To describe new onset of generalized seizures in 3 young dogs following cessation of a benzodiazepine-containing sedation protocol to facilitate mechanical ventilation (MV) for hypoxemia.Series Summary: Three dogs under 5 months of age underwent MV due to severe hypoxemia. All 3 dogs were sedated with a constant rate infusion of benzodiazepines as part of their sedation protocol to facilitate MV. All 3 dogs had an acute onset of generalized seizures within 36 hours of sedation cessation and weaning from MV. All 3 dogs' seizures were successfully managed with a slow, tapering course of benzodiazepines.One dog was additionally treated with levetiracetam at the time of initial seizure activity, which was discontinued 1 year following discharge and absence of ongoing seizure activity. All 3 dogs were discharged successfully with no reports of ongoing seizures or neurologic deficits after discharge.New or Unique Information Provided: Young dogs managed with benzodiazepines to facilitate MV may have acute onset of generalized seizures following cessation, which can be successfully managed with short-term benzodiazepine therapy. The 3 cases in this series demonstrated a positive outcome and were successfully managed following acute onset of generalized seizure activity post-MV.

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Section: Discussionmentioning

confidence: 99%

Suspected benzodiazepine withdrawal‐associated seizures in 3 young dogs undergoing mechanical ventilation

Walton

Enders

2022

J Vet Emergen Crit Care

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“…The study was approved by a Regional Board of Ethics in Sweden and permission to contact the participants was given by the head of the department. The study was conducted in accordance with the Declaration of Helsinki ( World Medical Association, 2013 ) and the four basic principles of research ethical principles in medical human research. All informants were guaranteed confidentiality and written informed consent was obtained from all study participants.…”

Section: Methodsmentioning

confidence: 99%

“…When a child is admitted to the Pediatric Intensive Care Unit (PICU), the care usually entails a mix of drug infusions. Sedative and analgesic drugs are administered as they enable treatment, and relieve discomfort and pain associated with the treatment of children ( Playfor & Vyas, 2000 ; Tonner et al, 2003 ; Whelan et al, 2015 ). The administration of potent opiates and sedative drugs are needed to facilitate respiratory care, prevent accidental self-extubation, and reduce stress and anxiety ( Playfor & Vyas, 2000 ; Tobias & Rasmussen, 1994 ; Tonner et al, 2003 ).…”

Section: Introductionmentioning

confidence: 99%

“…As an example, the use of midazolam for more than three days might trigger tachyphylaxis as well as physical dependence ( electronic Medicine Compendium [eMC], 2014 ). A study by Ista et al (2008 ) and Whelan et al (2015 ), describes withdrawal symptoms as agitation, anxiety, high muscle tension, insomnia < 1 h, diarrhea, fever, and sweating. Withdrawal symptoms might be misinterpreted as symptoms of an underlying disease by nurses when caring for a child with different drugs used simultaneously ( Madden et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

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Challenges in Nursing Care of Children With Substance Withdrawal Syndrome in the PICU

Mattsson¹

2022

SAGE Open Nursing

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Introduction Substance withdrawal is one of the most common advert events in the Pediatric Intensive Care Unit (PICU), as the administration of potent opiates and sedative drugs is frequently performed several times each day. Objectives The present study explored the challenges in nursing care of children with substance withdrawal syndrome in the PICU. Method The study has an explorative and descriptive semi-structured qualitative interview design, with a strategic selection of informants. It was conducted at one out of three pediatric intensive care units in Sweden. Results Three different main themes were identified describing the different challenges regarding withdrawal symptoms: monitor the child’s interest, work with structured support, and understand the observation. Conclusions There is a discrepancy between the medical perspective and the nursing care perspective regarding children in PICU suffering from withdrawal syndrome. The lack of joint guidelines, language, and nursing diagnoses may lead to subjective evaluations and increase suffering for these children.

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“…8 Nonetheless, assessment, prevention, and management of IWS continue to be challenging. 9 Best et al identified risk factors associated with IWS and found that duration of therapy and cumulative doses of opioids and benzodiazepines are the most predictive factor of IWS. 10 They also highlighted the need to further explore process, and system variables, such as sedation/IWS assessment, and protocol adherence.…”

Section: Introductionmentioning

confidence: 99%

Implementation of an algorithm for tapering analgosedation reduces iatrogenic withdrawal syndrome in pediatric intensive care

Dokken

Rustøen

Diep

et al. 2023

Acta Anaesthesiol Scand

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BackgroundProper analgosedation is a cornerstone in the treatment of critically ill patients in Pediatric Intensive Care Units (PICUs). Medications, such as fentanyl, morphine, and midazolam, are essential to safe and respectful care. The use of these medications over time may lead to side effects such as iatrogenic withdrawal syndrome (IWS) in the tapering phase. The aim of the study was to test an algorithm for tapering analgosedation to reduce the prevalence of IWS in two Norwegian PICUs at Oslo University Hospital.MethodsA cohort of mechanically ventilated patients from newborn to 18 years with continuous infusions of opioids and benzodiazepines for 5 days or more were included consecutively from May 2016 to December 2021. A pre‐ and posttest design, with an intervention phase using an algorithm for tapering analgosedation after the pretest, was used. The ICU staffs were trained in using the algorithm after the pretest. The primary outcome was a reduction in IWS. The Withdrawal Assessment Tool‐1 (WAT‐1) was used to identify IWS. A WAT‐1 score ≥3 indicates IWS.ResultsWe included 80 children, 40 in the baseline group, and 40 in the intervention group. Age and diagnosis did not differ between the groups. The prevalence of IWS was 95% versus 52.5% in the baseline group versus the intervention group, and the peak WAT‐1 median was 5.0 (IQR 4–6.8) versus 3.0 (IQR 2.0–6.0) (p = .012). Based on SUM WAT‐1 ≥ 3, which describes the burden over time better, we demonstrated a reduction of IWS, from a median of 15.5 (IQR 8.25–39) to a median of 3 (IQR 0–20) (p = <.001).ConclusionWe suggest using an algorithm for tapering analgosedation in PICUs since the prevalence of IWS was significantly lower in the intervention group in our study.

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Pediatric Withdrawal Identification and Management

Cited by 7 publications

References 25 publications

Suspected benzodiazepine withdrawal‐associated seizures in 3 young dogs undergoing mechanical ventilation

Suspected benzodiazepine withdrawal‐associated seizures in 3 young dogs undergoing mechanical ventilation

Challenges in Nursing Care of Children With Substance Withdrawal Syndrome in the PICU

Implementation of an algorithm for tapering analgosedation reduces iatrogenic withdrawal syndrome in pediatric intensive care

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