RT info:eu-repo/semantics/article
T1 Assessment and treatment of the withdrawal syndrome in paediatric intensive care units
A1 Ávila Alzate, Jennihe Alejandra
A1 Gómez Salgado, Juan
A1 Romero Martín, Macarena
A1 Martínez Isasi, Santiago
A1 Navarro Abal, Yolanda
A1 Fernández García, Daniel
A2 Enfermeria
K1 Enfermería
K1 Assessment tools
K1 Paediatric intensive care units
K1 Sedatives
K1 Treatment
K1 Opiates
K1 Latrogenic withdrawal syndrome
K1 3201.10 Pediatría
K1 3212 Salud Publica
K1 3205 Medicina Interna
AB [EN] AbstractBackground: Sedoanalgesia secondary iatrogenic withdrawal syndrome (IWS) in paediatric intensive units is frequent and itsassessment is complex. Therapies are heterogeneous, and there is currently no gold standard method for diagnosis. In addition, theassessment scales validated in children are scarce. This paper aims to identify and describe both the paediatric diagnostic andassessment tools for the IWS and the treatments for the IWS in critically ill paediatric patients.Methods: A systematic review was conducted according to the PRISMA guidelines. This review included descriptive andobservational studies published since 2000 that analyzed paediatric scales for the evaluation of the iatrogenic withdrawal syndromeand its treatments. The eligibility criteria included neonates, newborns, infants, pre-schoolers, and adolescents, up to age 18, whowere admitted to the paediatric intensive care units with continuous infusion of hypnotics and/or opioid analgesics, and whopresented signs or symptoms of deprivation related to withdrawal and prolonged infusion of sedoanalgesia.Results: Three assessment scales were identified: Withdrawal Assessment Tool-1, Sophia Observation Withdrawal Symptoms,and Opioid and Benzodiazepine Withdrawal Score. Dexmedetomidine, methadone and clonidine were revealed as options for thetreatment and prevention of the iatrogenic withdrawal syndrome. Finally, the use of phenobarbital suppressed symptoms ofdeprivation that are resistant to other drugs.Conclusions: The reviewed scales facilitate the assessment of the iatrogenic withdrawal syndrome and have a high diagnosticquality. However, its clinical use is very rare. The treatments identified in this review prevent and effectively treat this syndrome. Theuse of validated iatrogenic withdrawal syndrome assessment scales in paediatrics clinical practice facilitates assessment, have a highdiagnostic quality, and should be encouraged, also ensuring nurses’ training in their usage.Abbreviations: APD = acute pulmonary disease, BSS = Behavioural State Scale, BT = bacterial tracheitis, BZD =benzodiazepines, CASPe = Critical Appraisal Skills Programme España, CENTRAL = Cochrane Central Register of Controlled Trials.CINAHL = Cumulative Index to Nursing & Allied Health Literature, CNS = central nervous system, DBP = diastolic blood pressure,DXD = dexmedetomidine, DZM = diazepam, ECMO = extracorporeal oxygenation membrane, FNT = fentanyl, GA = gestationalAge, GI = gastrointestinal, HI = head injury, HR = heart Rate, ICI = Interclass Correlation Index, IQR = interquartile range, IVR =intravenous route, IWS = Iatrogenic Withdrawal Syndrome, LILACS = Latin American and Caribbean Literature in Health Sciences,LR = likehood ratio, LRZ = lorazepam, MDZ = midazolam, MeSH = Medical Subject Headings, MV = mechanical ventilation, NMB =neuromuscular blockers, NRS = Numerical Rating Scale, NWS = Neonatal Withdrawal Score, OBWS = Opioid and BenzodiazepineWithdrawal Score, OR = oral route, PB = phenobarbital, PH = pulmonary haemorrhage, PHT = pulmonary hypertension, PICU =Paediatric Intensive Care Units, PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PWI = PaediatricWithdrawal Inventory, RMF= Remifentanil, ROC = receiver operating characteristic, RR = respiratory rate, SBP = systolic blood pressure, SCC = Spearman Correlation Coefficient, SFT = sufentanyl, SOS = Sophia Observation Withdrawal Symptoms, Ttm =treatment, UMSS = University of Michigan Sedation Score, WAT = Withdrawal Assessment Tool.
PB Wolters Kluwer Health, Inc.
SN 0025-7974
LK https://hdl.handle.net/10612/21375
UL https://hdl.handle.net/10612/21375
NO Ávila-Alzate, J. A., Gómez-Salgado, J., Romero-Martín, M., Martínez-Isasi, S., Navarro-Abal, Y., & Fernández-García, D. (2020). Assessment and treatment of the withdrawal syndrome in paediatric intensive care units: Systematic review. Medicine, 99(5), e18502. https://doi.org/10.1097/MD.0000000000018502
DS BULERIA. Repositorio Institucional de la Universidad de León
RD 29-jun-2024