{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:41:08Z","timestamp":1790620868678,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T00:00:00Z","timestamp":1686096000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Proper analgosedation is a cornerstone in the treatment of critically ill patients in Pediatric Intensive Care Units (PICUs). Medications, such as fentanyl, morphine, and midazolam, are essential to safe and respectful care. The use of these medications over time may lead to side effects such as iatrogenic withdrawal syndrome (IWS) in the tapering phase. The aim of the study was to test an algorithm for tapering analgosedation to reduce the prevalence of IWS in two Norwegian PICUs at Oslo University Hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cohort of mechanically ventilated patients from newborn to 18\u2009years with continuous infusions of opioids and benzodiazepines for 5\u2009days or more were included consecutively from May 2016 to December 2021. A pre\u2010 and posttest design, with an intervention phase using an algorithm for tapering analgosedation after the pretest, was used. The ICU staffs were trained in using the algorithm after the pretest. The primary outcome was a reduction in IWS. The Withdrawal Assessment Tool\u20101 (WAT\u20101) was used to identify IWS. A WAT\u20101 score \u22653 indicates IWS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 80 children, 40 in the baseline group, and 40 in the intervention group. Age and diagnosis did not differ between the groups. The prevalence of IWS was 95% versus 52.5% in the baseline group versus the intervention group, and the peak WAT\u20101 median was 5.0 (IQR 4\u20136.8) versus 3.0 (IQR 2.0\u20136.0) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.012). Based on SUM WAT\u20101\u2009\u2265\u20093, which describes the burden over time better, we demonstrated a reduction of IWS, from a median of 15.5 (IQR 8.25\u201339) to a median of 3 (IQR 0\u201320) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009&lt;.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We suggest using an algorithm for tapering analgosedation in PICUs since the prevalence of IWS was significantly lower in the intervention group in our study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aas.14288","type":"journal-article","created":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T23:36:56Z","timestamp":1686181016000},"page":"1229-1238","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Implementation of an algorithm for tapering analgosedation reduces iatrogenic withdrawal syndrome in pediatric intensive care"],"prefix":"10.1111","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6698-9120","authenticated-orcid":false,"given":"Mette","family":"Dokken","sequence":"first","affiliation":[{"name":"Division of Emergencies and Critical Care, Paediatric Intensive Care Section Oslo University Hospital\u2010Rikshospitalet  Oslo Norway"},{"name":"Institute of Clinical Medicine, Faculty of Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tone","family":"Rust\u00f8en","sequence":"additional","affiliation":[{"name":"Division of Emergencies and Critical Care, Department of Research and Development Oslo University Hospital  Oslo Norway"},{"name":"Institute of Health Society, Faculty of Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lien My","family":"Diep","sequence":"additional","affiliation":[{"name":"Oslo Center for Biostatistics and Epidemiology, Research Support Services Oslo University Hospital  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frode Even","family":"Fagermoen","sequence":"additional","affiliation":[{"name":"Division of Emergencies and Critical Care, Department of Anesthesia and Intensive Care medicine Oslo University Hospital\u2010Rikshospitalet  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakel Iren","family":"Huse","sequence":"additional","affiliation":[{"name":"Division of Emergencies and Critical Care, Paediatric Intensive Care Section Oslo University Hospital\u2010Rikshospitalet  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Egerod","sequence":"additional","affiliation":[{"name":"Department of Intensive Care University of Copenhagen  Rigshospitalet Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunnar Kristoffer","family":"Bentsen","sequence":"additional","affiliation":[{"name":"Division of Emergencies and Critical Care, Department of Anesthesia and Intensive Care medicine Oslo University Hospital\u2010Rikshospitalet  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,6,7]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2009-0489"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-5153.2008.00311.x"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-013-2971-3"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/aas.13818"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40124-019-00187-4"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1081\/CLT-53099"},{"issue":"6","key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1097\/01.pcc.0000537945.25508.3b","article-title":"Evaluation of sedative and analgesic drug rotation protocol to decrease withdrawal syndrome in critically ill children with prolonged sedation","volume":"19","author":"Mencia S","year":"2018","journal-title":"Pediatr Crit Care Med"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2006.02180.x"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1556749"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000306"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2011.10.003"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001054"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000001953"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PCC.0000149318.40279.1A"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2013.07.009"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-016-4344-1"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.569"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e31818c8328"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/jep.13539"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.37616\/2212-5043.1268"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.12777"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000018502"},{"issue":"64","key":"e_1_2_12_24_1","first-page":"909","article-title":"Opioid tapering and weaning protocols in pediatric critical care units: a systematic review","volume":"2018","author":"Bichaff P","year":"1992","journal-title":"Rev Assoc Med Bras"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001719"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000002071"},{"key":"e_1_2_12_27_1","volume-title":"1306 Implementation of Withdrawal Assessment Tool and Weaning Protocol to Reduce Iatrogenic Withdrawal Syndrome in Pediatric Cardiac ICU: a Quality Improvement Project","author":"Elyas M","year":"2022"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/1740774511420743"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000197"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arcped.2022.11.001"}],"container-title":["Acta Anaesthesiologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aas.14288","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,22]],"date-time":"2023-09-22T20:46:46Z","timestamp":1695415606000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aas.14288"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,7]]},"references-count":29,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1111\/aas.14288"],"URL":"https:\/\/doi.org\/10.1111\/aas.14288","archive":["Portico"],"relation":{},"ISSN":["0001-5172","1399-6576"],"issn-type":[{"value":"0001-5172","type":"print"},{"value":"1399-6576","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,7]]},"assertion":[{"value":"2023-03-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}