An adult patient in the intensive care unit may be exposed to a number of addictive substances. Discontinuation of these agents can trigger withdrawal.
Patient selection: adult in the ICU
Features of withdrawal:
(1) agitation and irritability
(2) tremors
(3) hypertension
(4) tachycardia
(5) tachypnea
(6) sweating
(7) nausea and vomiting
(8) diarrhea
(9) fever
Addictive substances:
(1) opioids/opiates
(2) benzodiazepines
Risk factors for withdrawal:
(1) higher doses of the substances, especially fentanyl
(2) longer duration of substance use (and ICU stay), typically > 72 hours
(3) use of neuromuscular blocking agents and/or propofol
(4) failure to wean slowly
(5) therapy with antipsychotics
(6) chronic use of the substances prior to ICU admission
(7) alcoholism
Patients who experienced withdrawal often had long-term mechanical ventilation and/or sepsis.
