{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:24:32Z","timestamp":1777379072537,"version":"3.51.4"},"reference-count":46,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Anaesth Intensive Care"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:p>Limited data suggest a subset of patients with acute respiratory distress syndrome receive high-dose and prolonged opioid and sedative infusions. With prolonged use, patients may be at risk for developing iatrogenic withdrawal syndrome after discontinuation or tapering of these agents. Iatrogenic withdrawal syndrome is well described in paediatric patients; however, limited guidance exists in adult intensive care unit patients regarding risk factors and ideal management strategies. This article discusses several weaning strategies for high-risk patients to\u2009minimise withdrawal symptoms and safely reduce or discontinue opioid and sedative infusions. Ideal weaning strategies are lacking, but several options exist. These include a gradual reduction of the agent, changing the route of delivery by switching to an enteral or parenteral longer-acting agent from the same class, and substitution to an alternative agent to help mitigate potential withdrawal symptoms. This should be accomplished through a multidisciplinary approach by involving experts from relevant specialties while closely observing for withdrawal symptoms.<\/jats:p>","DOI":"10.1177\/0310057x241233604","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T22:32:48Z","timestamp":1747953168000},"page":"272-281","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Reduction of iatrogenic withdrawal syndrome in high-risk critically ill patients with acute respiratory distress syndrome"],"prefix":"10.1177","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4377-9221","authenticated-orcid":false,"given":"Ruchi P.","family":"Jain","sequence":"first","affiliation":[{"name":"Hackensack University Medical Center, Department of Pharmacy, Hackensack, NJ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katarzyna","family":"Gosek","sequence":"additional","affiliation":[{"name":"NewYork-Presbyterian Allen Hospital, New York, NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madeline","family":"Johnston","sequence":"additional","affiliation":[{"name":"HonorHealth John C. Lincoln Medical Center, Department of Pharmacy Services, Phoenix, AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003299"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000005131"},{"key":"e_1_3_4_4_2","first-page":"218","article-title":"Sedation in mechanically ventilated patients with COVID-19","volume":"9","author":"Page V.","year":"2021","unstructured":"Page V. Sedation in mechanically ventilated patients with COVID-19. Lancet 2021; 9.218\u2013219. doi:10.1016\/S2213-2600(20)30570-1","journal-title":"Lancet"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(20)30552-X"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2020-000591"},{"key":"e_1_3_4_7_2","first-page":"A2613","article-title":"Enteral methadone for iatrogenic opioid withdrawal in patients with COVID-19 acute respiratory distress syndrome: a case series","volume":"203","author":"Weiss M","year":"2021","unstructured":"Weiss M, Swoboda H, Chen E. Enteral methadone for iatrogenic opioid withdrawal in patients with COVID-19 acute respiratory distress syndrome: a case series. Am J Respir Crit Care Med 2021; 203: A2613. doi:10.1164\/ajrccm-conference.2021.203.1_MeetingAbstracts.A2613","journal-title":"Am J Respir Crit Care Med"},{"key":"e_1_3_4_8_2","article-title":"Weaning analgosedation in patients requiring prolonged mechanical ventilation","author":"Taylor SP","year":"2021","unstructured":"Taylor SP, Hammer JM, Taylor BT. Weaning analgosedation in patients requiring prolonged mechanical ventilation. J Intensive Care Med 2021. doi:10.1177\/08850666211048779","journal-title":"J Intensive Care Med"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.4037\/aacnacc2019267"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/1060028017724538"},{"key":"e_1_3_4_11_2","volume-title":"Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed)","author":"American Psychiatric Association","unstructured":"American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed). Arlington, VA: American Psychiatric Publishing, Inc."},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181de125a"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000035"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199804000-00015"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/000313480006600409"},{"key":"e_1_3_4_16_2","article-title":"Risk factors associated with opioid\/benzodiazepine iatrogenic withdrawal syndrome in COVID-19 acute respiratory distress syndrome","author":"Maffei MV","year":"2022","unstructured":"Maffei MV, Laehn S, Bianchini M, et\u00a0al. Risk factors associated with opioid\/benzodiazepine iatrogenic withdrawal syndrome in COVID-19 acute respiratory distress syndrome. J Pharm Pract 2022. doi:10.1177\/08971900221116178","journal-title":"J Pharm Pract"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200201000-00020"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000089"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2019559"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60105-1"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/0885066620951426"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1R132"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1559"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/phar.2017"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2016.03.023"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc11250"},{"key":"e_1_3_4_27_2","unstructured":"Fentanyl: Lexicomp online Lexi-Drugs Online. Hudon OH Wolters Kluwer Clinical Drug Information. https:\/\/online.lexi.com\/lco\/action\/home (accessed 4 June 2021)."},{"key":"e_1_3_4_28_2","first-page":"83","volume-title":"Demystifying opioid conversion calculations: A guide for effective dosing","author":"McPherson ML.","year":"2009","unstructured":"McPherson ML. Transdermal and parenteral fentanyl dosage calculations and conversions. In: McPherson ML(ed) Demystifying opioid conversion calculations: A guide for effective dosing. Bethesda, MD: American Society of Health-System Pharmacists, 2009, pp. 83\u2013106."},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(20011215)92:12<3056::AID-CNCR10166>3.0.CO;2-H"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1111\/apa.14327"},{"key":"e_1_3_4_31_2","first-page":"167","article-title":"Benzodiazepine dependence and withdrawal: identification and medical management","volume":"5","author":"Landry MJ","year":"1992","unstructured":"Landry MJ, Smith DE, McDuff DR, et\u00a0al. Benzodiazepine dependence and withdrawal: identification and medical management. J Am Board Fam Pract 1992; 5: 167\u2013176.","journal-title":"J Am Board Fam Pract"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001687"},{"key":"e_1_3_4_33_2","unstructured":"Phenobarbital sodium injection (PhenobarbTM) [package insert]. Cameron Pharmaceuticals LLC Louisville KY; 2021."},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2011.12.011"},{"key":"e_1_3_4_35_2","unstructured":"Dexmedetomidine (PrecedexTM) [package insert]. Hospira Inc; Lake Forest IL; 2013."},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1002\/phar.2323"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2020.10.024"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.1177\/0960327112454896"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2020.06.006"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.56"},{"key":"e_1_3_4_41_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.304"},{"key":"e_1_3_4_42_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000245"},{"key":"e_1_3_4_43_2","doi-asserted-by":"publisher","DOI":"10.1177\/0885066620933798"},{"key":"e_1_3_4_44_2","doi-asserted-by":"publisher","DOI":"10.1177\/1060028020919122"},{"key":"e_1_3_4_45_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003633"},{"key":"e_1_3_4_46_2","doi-asserted-by":"publisher","DOI":"10.18773\/austprescr.2018.021"},{"key":"e_1_3_4_47_2","unstructured":"Medication Safety in Transitions of Care. Geneva: World Health Organization; 2019 (WHO\/UHC\/SDS\/2019.9) https:\/\/www.who.int\/publications\/i\/item\/WHO-UHC-SDS-2019.9 (accessed 5 March 2024)."}],"container-title":["Anaesthesia and Intensive Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0310057X241233604","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0310057X241233604","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0310057X241233604","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:13:06Z","timestamp":1777367586000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0310057X241233604"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,22]]},"references-count":46,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1177\/0310057X241233604"],"URL":"https:\/\/doi.org\/10.1177\/0310057x241233604","relation":{},"ISSN":["0310-057X","1448-0271"],"issn-type":[{"value":"0310-057X","type":"print"},{"value":"1448-0271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,22]]}}}