960: OPIOID AND SEDATIVE WEANING AND WITHDRAWAL IN MECHANICALLY VENTILATED ADULTS: AN ALERT-ICU SUBSTUDY
Bibliographic record
Abstract
Introduction: Iatrogenic withdrawal syndrome (IWS) occurs with prolonged use and high doses of opioids and sedatives, and weaning through gradual dose reductions may minimize the risk of IWS. This study examined opioid and sedative weaning and IWS policies/protocols in critically ill adults receiving invasive mechanical ventilation (MV). We hypothesized that opioid and sedative weaning and IWS policies/protocols are underutilized in this population. Methods: This was a post-hoc analysis of an international, observational, point prevalence study on a single date between June 1 and September 30, 2021. Enrollment criteria were ICU patients 18 years or older on invasive MV who received parenteral opioids or sedatives in the past 24 hours. The primary outcome was the proportion of patients who had parenteral opioids and/or sedatives weaned by an institutional policy/protocol. Parametric and nonparametric statistical analyses were performed using IBM SPSS Statistics version 28.0.0 (Armonk, New York) according to the level of measurement, data distribution, and assumptions. The a priori alpha was 5%. Results: There were 2402 patients screened for enrollment at 87 hospitals in 229 ICUs from 11 countries, of which 1066 were enrolled. Most patients (50%) were from the US, with a mean age of 55 (SD ± 16) years. Females accounted for 38%, 50% were admitted for respiratory disease, and 37% tested PCR positive for COVID-19. The median ICU stay was 7 (IQR, 3-16) days, and 40% of patients developed ARDS. The median duration of MV was 4.6 (IQR, 1.4-11.5) days. Opioids were administered to 938 (88%), sedatives to 932 (87%), and their combination to 804 (75%) patients. Among enrolled patients, 35% were admitted to 90 ICUs with a weaning protocol, while 6% were admitted to 23 ICUs with a withdrawal protocol. By the day of data collection, 39% of patients used a weaning protocol for analgesia-sedation, while 12% used a withdrawal protocol in ICUs with such protocols. Conclusions: Opioid and sedative weaning and IWS policies/protocols are underutilized in the ICU, as only a small proportion of patients had one implemented by the data collection day. About one-third of patients were admitted to an ICU with a weaning protocol, and about 1 in 17 to an ICU with a withdrawal protocol.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".