Sedation/Analgesia, PICU, Mechanically Ventilated Patient — Monitor Withdrawal Symptoms — Clinical Pathway: ICU

Sedation/Analgesia, Mechanically Ventilated Patient Clinical Pathway — PICU

Monitor Withdrawal Symptoms

  • Physical signs, symptoms manifest when opioid or benzodiazepine administration is abruptly discontinued
  • Symptoms mimic many clinical conditions
  • Can appear up to 2-3 days after decreasing/stopping medication (can be longer with methadone)
  • Diagnosis of exclusion, assess for other conditions with similar symptoms:
    • Hypoxia
    • Hypercarbia
    • Electrolyte Imbalance
    • Metabolic Dysfunction
    • Low Cardiac Output
    • Sepsis
    • Feeding Intolerance

Common Withdrawal Symptoms

Central Nervous SystemGastrointestinal DisturbancesAutonomic Dysfunction
  • Poor sleep pattern
  • Irritability
  • Tremors Convulsions Uncoordinated suck/swallow
  • Hallucinations
  • Diarrhea
  • Vomiting
  • Gagging
  • Abdominal pain
  • Increased secretions
  • Fever
  • Sweating
  • Yawning
  • Piloerection
  • Tachycardia
  • Hypertension
  • Tachypnea

Withdrawal Assessment Tool Version 1 (WAT - 1) and Instructions  

Note: Consider the patient’s baseline (i.e. pre-sedation or pre-weaning) status with regard to chronic underlying symptoms that could be incorrectly misinterpreted as withdrawal. Withdrawal symptoms mimic many clinical conditions. When evaluating the patient, physicians should assess for conditions such as low cardiac output syndrome, hypoxia, hypercarbia, sepsis, electrolyte imbalances, feeding intolerance, and metabolic dysfunctions that can present with symptoms similar to withdrawal syndrome. Withdrawal syndrome is a diagnosis of exclusion. It should be kept in mind that severe signs and symptoms of withdrawal can appear up to two- three days after a decrease or cessation of sedation medication (may be longer with methadone).