SynthesisPediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies2015
Risk factors associated with iatrogenic opioid and benzodiazepine withdrawal in critically ill pediatric patients: a systematic review and conceptual model.
Synthesis in Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
35 citing papers in PubMed, 2 syntheses or guidelines pooled it, 101 citations in OpenAlex.
- Pooled it
- Assessment and treatment of the withdrawal syndrome in paediatric intensive care units: Systematic review.Medicine · 2020Pooled it
- A Neonatal Nurse-Controlled Model of Analgesia to Manage Post-Operative Pain in the Surgical Neonate: A Pilot Randomised Controlled Trial.Journal of advanced nursing · 2026Trial
- Effective alleviation of depressive and anxious symptoms and sleep disorders in benzodiazepine-dependent patients through repetitive transcranial magnetic stimulation.Addiction biology · 2024Trial
- Sedation Management for Critically Ill Children with Pre-Existing Cognitive Impairment.The Journal of pediatrics · 2019Trial
- The Association of Iatrogenic Withdrawal With Opioid and Benzodiazepine Weaning in Children With Bronchiolitis: A Single-Center, Retrospective Cohort Study, 2012-2022.Critical care explorations · 2026Article
- A deep learning model for estimating sedation levels using heart rate variability and vital signs: a retrospective cross-sectional study at a center in South Korea.Acute and critical care · 2024Article
- Predicting functional and quality-of-life outcomes following pediatric sepsis: performance of PRISM-III and PELOD-2.Pediatric research · 2023Article
- Analgesia and sedation in critically ill pediatric patients: an update from the recent guidelines and point of view.European journal of pediatrics · 2023Review
- Suspected benzodiazepine withdrawal-associated seizures in 3 young dogs undergoing mechanical ventilation.Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001) · 2022Article
- Aromatherapy massage seems effective in critically ill children: an observational before-after study.Paediatric & neonatal pain · 2022Article
- Recommendations for analgesia and sedation in critically ill children admitted to intensive care unit.Journal of anesthesia, analgesia and critical care · 2022Review
- Quality of clinical practice guidelines and recommendations for the management of pain, sedation, delirium and iatrogenic withdrawal in pediatric intensive care: a systematic review protocol.BMJ paediatrics open · 2022Article
- Midazolam nasal spray to treat intermittent, stereotypic episodes of frequent seizure activity: pharmacology and clinical role, a comprehensive review.Health psychology research · 2022Article
- Four-in-One: A Comprehensive Checklist for the Assessment of Pain, Undersedation, Iatrogenic Withdrawal and Delirium in the PICU: A Delphi Study.Frontiers in pediatrics · 2022Article
- Towards Evidence-Based Weaning: a Mechanism-Based Pharmacometric Model to Characterize Iatrogenic Withdrawal Syndrome in Critically Ill Children.The AAPS journal · 2021Article
- Haloperidol and Quetiapine for the Treatment of ICU-Associated Delirium in a Tertiary Pediatric ICU: A Propensity Score-Matched Cohort Study.Paediatric drugs · 2021Article
- Analgesia in the Neurosurgical Intensive Care Unit.Frontiers in neurology · 2021Review
- Iatrogenic Withdrawal Syndrome in the Pediatric Cardiac Intensive Care Unit: Incidence, Risk Factors and Outcome.Journal of the Saudi Heart Association · 2021Article
- Exposure-Based Methadone and Lorazepam Weaning Protocol Reduces Wean Length in Children.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2021Article
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
objectivesAnalgesia and sedation are common therapies in pediatric critical care, and rapid titration of these medications is associated with iatrogenic withdrawal syndrome. We performed a systematic review of the literature to identify all common and salient risk factors associated with iatrogenic withdrawal syndrome and build a conceptual model of iatrogenic withdrawal syndrome risk in critically ill pediatric patients. DATA SOURCES: Multiple databases, including PubMed/Medline, EMBASE, CINAHL, and the Cochrane Central Registry of Clinical Trials, were searched using relevant terms from January 1, 1980, to August 1, 2014. STUDY SELECTION: Articles were included if they were published in English and discussed iatrogenic withdrawal syndrome following either opioid or benzodiazepine therapy in children in acute or intensive care settings. Articles were excluded if subjects were neonates born to opioid- or benzodiazepine-dependent mothers, children diagnosed as substance abusers, or subjects with cancer-related pain; if data about opioid or benzodiazepine treatment were not specified; or if primary data were not reported. DATA EXTRACTION: In total, 1,395 articles were evaluated, 33 of which met the inclusion criteria. To facilitate analysis, all opioid and/or benzodiazepine doses were converted to morphine or midazolam equivalents, respectively. A table of evidence was developed for qualitative analysis of common themes, providing a framework for the construction of a conceptual model. The strongest risk factors associated with iatrogenic withdrawal syndrome include duration of therapy and cumulative dose. Additionally, evidence exists linking patient, process, and system factors in the development of iatrogenic withdrawal syndrome.
findingsMost articles were prospective observational or interventional studies.
conclusionsGiven the state of existing evidence, well-designed prospective studies are required to better characterize iatrogenic withdrawal syndrome in critically ill pediatric patients. This review provides data to support the construction of a conceptual model of iatrogenic withdrawal syndrome risk that, if supported, could be useful in guiding future research.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.