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Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Following prolonged opioid and\/or hypnotic exposure, iatrogenic withdrawal syndrome (IWS) can develop in critically ill patients due to improper cessation of these drugs. While IWS is well-documented in pediatric and neonatal intensive care unit (ICU), research on adult ICU patients remains scarce. This scoping review aimed to map existing evidence on IWS in critically ill adults, focusing on diagnosis, epidemiology, risk factors, complications, clinical effects, treatment, and prevention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A literature search across PubMed, Scopus, and Web of Science included studies from 1990 to 2024 with prospective, retrospective, or randomized controlled trial designs. Out of 3105 retrieved titles, 29 studies met inclusion criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Most studies addressed diagnosis (83%) and epidemiology (79%), with IWS definitions largely adapted from chronic drug users. Incidence varied from 13.6 to 49.5%. Several studies identified risk factors, primarily therapy-related, but only some performed robust statistical analyses. Complications and clinical effects were discussed in 12 studies but results on ICU and hospital outcomes were inconsistent. Physiological studies linked IWS to sympathetic overactivity and central nervous system excitability. Only 20% of studies examined treatment or prevention, with randomized trials assessing substitution therapy. Most strategies did not significantly alter IWS incidence, though clonidine showed potential benefits.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>This review highlights critical knowledge gaps and the lack of consensus or guidelines for IWS in adult ICU patients, emphasizing the need for further research.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1573363","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T05:37:11Z","timestamp":1753249031000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Iatrogenic withdrawal syndrome in adult intensive care unit: a scoping review"],"prefix":"10.3389","volume":"12","author":[{"given":"Emanuel","family":"Moisa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgeana","family":"Tuculeanu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Corneci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvius Ioan","family":"Negoita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Bilotta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"353","DOI":"10.4037\/AACNACC2019267","article-title":"Opioid and benzodiazepine iatrogenic withdrawal syndrome in patients in the intensive care unit.","volume":"30","author":"Arroyo-Novoa","year":"2019","journal-title":"AACN Adv Crit Care."},{"key":"B2","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1038\/NPP.2009.110","article-title":"Neurocircuitry of addiction.","volume":"35","author":"Koob","year":"2010","journal-title":"Neuropsychopharmacology."},{"key":"B3","author":"Ries Richard, Miller","year":"2015","journal-title":"The ASAM principles of addiction medicine."},{"key":"B4","doi-asserted-by":"publisher","first-page":"4717","DOI":"10.3389\/FPED.2023.1264717","article-title":"A systematic review of clinical practice guidelines and recommendations for the management of pain, sedation, delirium and iatrogenic withdrawal syndrome in pediatric intensive care.","volume":"11","author":"MacDonald","year":"2023","journal-title":"Front Pediatr."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1502","DOI":"10.1097\/CCM.0000000000005951","article-title":"International analgesia and sedation weaning and withdrawal practices in critically ill adults: The adult iatrogenic withdrawal study in the ICU.","volume":"51","author":"Bolesta","year":"2023","journal-title":"Crit Care Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"103452","DOI":"10.1016\/J.ICCN.2023.103452","article-title":"Critical care nurses\u2019 experiences of caring for patients with iatrogenic opioid withdrawal in the intensive care unit: A qualitative study.","volume":"78","author":"Lindberg","year":"2023","journal-title":"Intensive Crit Care Nurs."},{"key":"B7","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1097\/00003246-199804000-00015","article-title":"Acute withdrawal syndrome related to the administration of analgesic and sedative medications in adult intensive care unit patients.","volume":"26","author":"Cammarano","year":"1998","journal-title":"Crit Care Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1080\/03007995.2021.1928616","article-title":"Incidence and clinical manifestation of iatrogenic opioid withdrawal syndrome in mechanically ventilated patients.","volume":"37","author":"Taesotikul","year":"2021","journal-title":"Curr Med Res Opin."},{"key":"B9","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1016\/J.MEDIN.2015.06.008","article-title":"Impact of harmful use of alcohol on the sedation of critical patients on mechanical ventilation: A multicentre prospective, observational study in 8 Spanish intensive care units.","volume":"40","author":"Sandiumenge","year":"2016","journal-title":"Med Intensiva."},{"key":"B10","doi-asserted-by":"publisher","first-page":"E0904","DOI":"10.1097\/CCE.0000000000000904","article-title":"Prevalence and risk factors for iatrogenic opioid withdrawal in medical critical care patients.","volume":"5","author":"Fox","year":"2023","journal-title":"Crit Care Explor."},{"key":"B11","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1007\/S00134-005-2579-3","article-title":"Withdrawal following sufentanil\/propofol and sufentanil\/midazolam. 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