REVIEW article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1573363
This article is part of the Research TopicOpioids and Pain in Older AdultsView all articles
Iatrogenic withdrawal syndrome in adult intensive care unit: a scoping review
Provisionally accepted
- 1Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- 2Elias University Emergency Hospital, Bucharest, Romania
- 3Dr. Carol Davila Central Military Emergency University Hospital, Buchatest, Romania
- 4Sapienza University of Rome, Rome, Lazio, Italy
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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. 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. 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. 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.
Keywords: iatrogenic withdrawal syndrome, opioid, benzodiazepine, hypnotics, Dexmedetomidine, Clonidine, sedation
Received: 08 Feb 2025; Accepted: 26 Jun 2025.
Copyright: © 2025 Moisa, Tuculeanu, Corneci, Negoita and Bilotta. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Emanuel Moisa, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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