Incidence of Withdrawal Symptoms in Pediatric Intensive Care Units after Using the Guidelines for Prevention and Treatment of Withdrawal from Opioid Analgesics and Benzodiazepine Sedatives of the Queen Sirikit National Institute of Child Health (QSNICH)
Keywords:
Incidence, Opioid withdrawal, Benzodiazepine withdrawal, Pediatric critical careAbstract
Background: Opioid drugs in combination with benzodiazepines are widely used in pediatric intensive care units (PICUs). These medications are prescribed to reduce pain from illness and medical procedures and to assist patients in breathing with a ventilator. Most patients receive these drugs through continuous intravenous infusion for an extended period. Abrupt discontinuation or rapid dose reduction may lead to withdrawal symptoms. Queen Sirikit National Institute of Child Health has developed guidelines for the prevention and treatment of withdrawal from opioid analgesics and benzodiazepine sedatives to be used in the PICU. It also uses the Withdrawal Assessment Tool Version 1 (WAT-1) to assess opioid and benzodiazepine withdrawal symptoms. Objectives: To determine the incidence of opioid and benzodiazepine withdrawal symptoms, as well as the cumulative dose and average duration of fentanyl or morphine administration in combination with midazolam among patients experiencing drug withdrawal. Methods: This descriptive study was conducted by collecting data from pediatric patients in the PICU at Queen Sirikit National Institute of Child Health. From January 1, 2023 to July 10, 2024, 64 patients, aged between 2 months and 18 years, participated in the study. All patients were managed using the withdrawal prevention and treatment guidelines. Results: Among 64 participants, aged 2 months to 16 years, 19 patients (29.7%) experienced withdrawal symptoms. Of these, 17 patients (89.5%) received midazolam combined with fentanyl, and 2 patients (10.5%) received midazolam combined with morphine. The average cumulative doses of midazolam, fentanyl, and morphine were 28.99, 0.44, and 5.59 mg/kg, respectively. The average duration from opioid and benzodiazepine administration to the onset of withdrawal symptoms was 7.74 days. Conclusions: The incidence of opioid or benzodiazepine withdrawal from continuous intravenous infusion, as assessed by the WAT-1 tool, was 29.7%.
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