Opioid and Benzodiazepine Iatrogenic Withdrawal Syndrome in Patients in the Intensive Care Unit.
Carmen Mabel Arroyo-Novoa, Milagros I Figueroa-Ramos, Kathleen A Puntillo
PMID 31951658WHAT IT FOUND
Adult ICU patients weaned from opioids or benzodiazepines may develop withdrawal caused by treatment, but evidence is sparse and tools are unvalidated.
Nurses should screen exposure, watch nonspecific signs, and wean slowly.
Key findings
01Reported prevalence varied widely: 32% to 100% for mixed opioid and benzodiazepine withdrawal and 16.6% to 20.7% for opioid withdrawal, but these figures came from small studies with different inclusion criteria.
02No validated adult ICU withdrawal assessment tool was available; the pediatric WAT-1 had specificity of 65.9% and sensitivity of 50% and was judged not valid for adults.
03Nurses can raise suspicion by asking about prior opioid or benzodiazepine use and monitoring nonspecific signs such as restlessness, agitation, delirium, diarrhea, fever, tachypnea, insomnia, and muscle ache.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The article is a review, not a systematic search, so its conclusions reflect selected reports and guideline interpretations. Most cited studies were small observational reports or conference abstracts, and several used retrospective chart data. No validated assessment tool for adult ICU withdrawal was available, and the pediatric WAT-1 was not valid for adults. Many ICU patients received opioids and benzodiazepines together and were weaned from both, so the contribution of any single drug cannot be separated. Withdrawal signs are not specific and overlap with common ICU conditions, so diagnosis is uncertain. The proposed nursing algorithm has not been tested.
The easy way to misread this
Do not conclude that opioid or benzodiazepine withdrawal is a common, specific diagnosis in adult ICU patients. The review reports wide prevalence ranges only from small, heterogeneous studies, says signs overlap with other conditions, and notes no validated adult assessment tool.