Table 2:
Study Characteristics
| Authors and Study Design | Sample Characteristics | Minimum Duration of Exposure to OP/BNZ | Method of IWS Assessment | Assessment Frequency and Duration | IWS Prevalence and Type |
|---|---|---|---|---|---|
| Cammarano et al (1998)15 Observational, retrospective | n = 28 trauma/surgical patients; MV, drug naive and history of chronic drug use | ≥7 days | Record review; common S&S of WS, diagnosis of analgesic/sedative-related WS, prescription of clonidine to treat OP IWS | Not reported | 32.1% mixed IWS |
| Brown et al (2000)7 Observational, retrospective | n = 11 burn patients; MV, drug naive | ≥ 7 days | Record review; scoring system of common S&S of WS | Not reported | 100% mixed IWS |
| Korak-Leiter et al (2005)8 Interventional RCT (OP/BNZ vs OP/ propofol) | n = 29 general or cardiac surgical patients; MV, drug naive | Not defined | Prospective assessment by 2 independent observers; scoring system of common S&S of WS | Start of MV weaning (beginning of 30% reduction in OP/BNZ), at the end of MV weaning, and 6, 12, and 24 h after stopping sedation | OP IWS 35% sufentanil/midazolam 28% sufentanil/propofol |
| Wang et al (2017)9 Observational, prospective | n = 54 trauma patients; MV, drug naive | > 3 days | Prospective assessment by an ICU physician; S&S of OP IWS from DSM-5 | Once a day upon OP weaning during ICU stay and until 48 h after a DSM-5 positive or extubation, or 14 d after a successful weaning process | 16.7% OP IWS |
| Arroyo-Novoa et al (2018)10,11 Observational, prospective | n = 50 trauma patients; MV or non-MV, drug naive or his- tory of chronic drug use | > 5 days | Prospective assessment by 1 investigator; S&S checklist from DSM-5 or ICD-10, and common S&S from previous studies of WS | Twice a day for 72 h after starting the OP or BNZ weaning; if failed, WS assessment began when weaning was reestablished and continued for up to 72 h | 44% mixed IWS |
| Hyun et al (2018)12 Observational, retrospective | n = 126 medical patients (drug experience and MV status not reported) | ≥ 3 days | Record review; ≥ 2 CNS or autonomic symptoms | Upon OP reduction to half or discontinuation using specific time according to the OP drug (2 h for remifentanil, 10 h for fentanyl, 8 h for morphine) | 16.6% OP IWS |
| Zerrouki et al (2019)14 Observational, prospective | n = 29 MV patients (type of patient and drug experience not reported) | > 3 days | Prospective assessment; standardized form of S&S of WS by investigator (assumed) and with a modified DSM-5 by a physician | Daily after at least 10% OP reduction (duration not reported) | 20.7% OP IWS |
| Taesotikul et al (2019)13Observational, prospective | n = 39 MV patients (type of patient and drug experience not reported) | ≥ 2 days | Prospective assessment by investigator (assumed); S&S of WS in DSM-5 | 1, 3, 6, 24, and 72 h after reduction or discontinuation of fentanyl | 20.5% OP (fentanyl) IWS |
Abbreviations: BNZ, benzodiazepine; CNS, central nervous system; DSM-5, Diagnostic and Statistical Manual of Mental Disorders, 5th edition; ICD-10, International Statistical Classification of Diseases and Related Health Problems, 10th revision; ICU, intensive care unit; IWS, iatrogenic withdrawal syndrome; MV, mechanically ventilated; OP, opioid; RCT, randomized clinical trial; S&S, signs and symptoms; WS, withdrawal syndrome.