{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:59:29Z","timestamp":1787497169077,"version":"build-2736575974"},"reference-count":41,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T00:00:00Z","timestamp":1686528000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Analgesia and sedation are essential for the care of children in the pediatric intensive care unit (PICU); however, when prolonged, they may be associated with iatrogenic withdrawal syndrome (IWS) and delirium. We sought to evaluate current practices on IWS and delirium assessment and management (including non\u2010pharmacologic strategies as early mobilization) and to investigate associations between the presence of an analgosedation protocol and IWS and delirium monitoring, analgosedation weaning, and early mobilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a\u00a0multicenter cross\u2010sectional survey\u2010based study collecting data from one experienced physician or nurse per PICU in Europe from January to April 2021. We then investigated differences among PICUs that did or did not follow an analgosedation protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 357 PICUs, 215 (60%) responded across 27 countries. IWS was systematically monitored with a validated scale in 62% of PICUs, mostly using the Withdrawal Assessment Tool\u20101 (53%). The main first\u2010line treatment for IWS was a rescue bolus with interruption of weaning (41%). Delirium was systematically monitored in 58% of PICUs, mostly with the Cornell Assessment of Pediatric Delirium scale (48%) and the Sophia Observation Scale for Pediatric Delirium (34%). The main reported first\u2010line treatment for delirium was dexmedetomidine (45%) or antipsychotic drugs (40%). Seventy\u2010one percent of PICUs reported to follow an analgosedation protocol. Multivariate analyses adjusted for PICU characteristics showed that PICUs using a protocol were significantly more likely to systematically monitor IWS (odds ratio [OR] 1.92, 95% confidence interval [CI] 1.01\u20133.67) and delirium (OR 2.00, 95% CI 1.07\u20133.72), use a protocol for analgosedation weaning (OR 6.38, 95% CI 3.20\u201312.71) and promote mobilization (OR 3.38, 95% CI 1.63\u20137.03).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Monitoring and management of IWS and delirium are highly variable among European PICUs. The use of an analgosedation protocol was associated with an increased likelihood of monitoring IWS and delirium, performing a structured analgosedation weaning and promoting mobilization. Education on this topic and interprofessional collaborations are highly needed to help reduce the burden of analgosedation\u2010associated adverse outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/phar.2831","type":"journal-article","created":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T03:23:47Z","timestamp":1684466627000},"page":"804-815","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Assessment and management of iatrogenic withdrawal syndrome and delirium in pediatric intensive care units across Europe: An\n                    <scp>ESPNIC<\/scp>\n                    survey"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7109-0582","authenticated-orcid":false,"given":"Francesca","family":"Sperotto","sequence":"first","affiliation":[{"name":"Cardiovascular Critical Care Unit Department of Cardiology Boston Children's Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8809-2920","authenticated-orcid":false,"given":"Anne\u2010Sylvie","family":"Ramelet","sequence":"additional","affiliation":[{"name":"Institute of Higher Education and Research in Healthcare Faculty of Biology and Medicine University of Lausanne  Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3127-8836","authenticated-orcid":false,"given":"Marco","family":"Daverio","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit Department of Women's and Children's Health University Hospital of Padua  Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8398-3166","authenticated-orcid":false,"given":"Maria Cristina","family":"Mondardini","sequence":"additional","affiliation":[{"name":"Pediatric Anesthesia and Intensive Care Unit Department of Woman's and Child's Health IRCCS University Hospital of Bologna Policlinico S.Orsola  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"von Borell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universit\u00e4t Dresden  Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3666-7128","authenticated-orcid":false,"given":"Sebastian","family":"Brenner","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universit\u00e4t Dresden  Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4331-5398","authenticated-orcid":false,"given":"Dick","family":"Tibboel","sequence":"additional","affiliation":[{"name":"Intensive Care and Department of Paediatric Surgery Erasmus MC\u2010Sophia Children\u2019s Hospital University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1257-3108","authenticated-orcid":false,"given":"Erwin","family":"Ista","sequence":"additional","affiliation":[{"name":"Department of Neonatal &amp; Pediatric Intensive Care Division Pediatric Intensive Care, Erasmus MC\u2010Sophia Children\u2019s Hospital University Medical Center Rotterdam  Rotterdam Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Pokorna","sequence":"additional","affiliation":[{"name":"Department of Neonatal &amp; Pediatric Intensive Care Division Pediatric Intensive Care, Erasmus MC\u2010Sophia Children\u2019s Hospital University Medical Center Rotterdam  Rotterdam Netherlands"},{"name":"Institute of Pharmacology First Faculty of Medicine Charles University and General University 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