Iatrogenic opioid withdrawal syndromes in adults in intensive care units: a narrative review

Background and Objective: In hospitalized patients, opiates are essential analgesics and sedatives used in intensive care unit (ICU) patients. However, the iatrogenic opioid withdrawal syndrome (IOWS) in ICU patients has been poorly characterized, and there are no well accepted, standardized diagnostic tools for hospitalized adults. This review analyzed recent clinical studies to determine the frequency, characteristics, and treatment of IOWS in critically ill adults. Methods: The initial literature search used the PubMed MeSH terms Analgesics, Opioids, Iatrogenic Disease, and Neurobiology. The main focus was on clinical studies describing IOWS in adults receiving intravenous opioids in ICUs. Key Content and Findings: Review of 8 studies indicated that IOWS occurs in 15 to 40% of patients in intensive care units who required opioid infusions. These reports included patients in medical ICUs, trauma ICUs, surgical ICUs, and burn ICUs; many patients also received sedative drugs. Most of the studies used DSM-5 criteria to identify the syndrome. Factors which predicted the development of this syndrome varied from study to study; important considerations included the weaning rate for the opioid, the duration of opioid infusion, and the concomitant infusion of benzodiazepines. Treatment approaches included the reinstitution of the opioid infusion with slower reductions in the rate and the use of an alpha-2 agonist, such dexmedetomidine or clonidine. Many patients appeared to recover without specific treatment. Conclusions: This review demonstrates that this syndrome occurs at relatively high frequency in ICU patients requiring mechanical ventilation. More research on developing diagnostic tools for IOWS is needed.

Automated summary

This review analyzed clinical studies to determine the frequency, characteristics, and treatment of iatrogenic opioid withdrawal syndrome (IOWS) in critically ill adults. The review found that IOWS occurs in 15 to 40% of ICU patients who required opioid infusions, and factors such as weaning rate, duration of infusion, and concomitant benzodiazepine use influenced the development of the syndrome. Treatment approaches included slower reductions in the rate of infusion and the use of an alpha-2 agonist. More research is needed to develop diagnostic tools for IOWS.