(1014) Evaluation of Protocolized Sedation Weaning for Iatrogenic Withdrawal Syndrome in the Pediatric ICU

Introduction: Protocolized sedation weaning has shown improved outcomes compared to non-protocolized weaning in the setting of iatrogenic withdrawal syndrome (IWS). Many protocols have been created but a standardized protocol has yet to be found superior. The purpose of this study was to evaluate our institutions previously followed opioid and benzodiazepine IWS protocol to our current practice of patient modified IWS protocol to evaluate for changes based on protocol utilized.

Methods: A retrospective cohort from 1/1/2017 to 9/30/2022 was evaluated with two cohorts defined as following exact protocol from 1/1/2017 to 12/31/2019 and modified protocol from 1/1/2020 to 9/30/2022. Inclusion criteria included patients ≤ 18 years admitted to the PICU requiring enteral methadone for IWS. Exclusion criteria included patients with failure to complete wean inpatient, death, requiring re-intubation during wean, or utilizing methadone for an alternative indication. The primary objective was to compare the duration of weaning when utilizing the exact vs modified weaning protocol. Secondary objectives included comparing WAT-1 scores and length of stay (LOS) for both critical care and hospital when utilizing the weaning protocols.

Results: Fifty patients met inclusion criteria, with 30 patients in the exact and 20 patients in the modified IWS protocol. The duration of weaning decreased from using the exact to the patient modified protocol by 2.5 days (9 vs 6.5 days, p=0.1). Median WAT-1 scores were higher in the patient modified protocol compared to the exact (2 vs 1, p=0.03). Critical care and hospital LOS decreased from the exact to the patient modified protocol (22.5 vs 13.5 days, p=0.03 and 29.5 vs 19 days, p=0.047, respectively).

Conclusions: Modifying the IWS weaning protocol to a patient modified protocol saw a non-statistically, but potentially clinically significant decrease in duration of IWS weaning, which potentially impacted the significant decrease in LOS. However, the modified protocol saw an increase in withdrawal with WAT-1 scores. Further studies are required to elucidate the effect of patient modified IWS protocols on wean duration and LOS, and the development of strategies to decrease withdrawal.