LAUSR

Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives: Withdrawal from opioid (OPI) and benzodiazepines (BZDs) in critically ill pediatric patients causes physiological and psychological stress and prolongs hospitalization. Significant practice variation exists within and between institutions with regards to weaning. There is limited published data on OPI weaning and even less for BZD weaning. While cumulative exposure is an important determinate of withdrawal risk, a majority of OPI protocols do not account for current dose and total duration in formulating a weaning plan. We hypothesized that a standardized METH and LORAZ weaning protocol based on dose and duration of exposure will reduce the length of weaning and hospital length of stay. Methods: A retrospective cohort of Pediatric ICU patients on infusions for greater than three days (June 2012-June 2013) were compared to a cohort after the implementation of a standardized weaning protocol for methadone (METH) and lorazepam (LORAZ) (March 2014-March 2015). Patients were categorized into wean groups based on the duration of infusions of > 3 days up to 5 days, 5 days up to 14 days, and > = 14 days. Patients treated with METH or BZDs for ongoing pain or anxiety, died, or were transferred before completing therapy were excluded. Results: A total of 107 patients were included; 75 before and 102 after protocol implementation. Patient age, weight, gender, ethnicity, and primary diagnosis were similar in both. The median days on METH for patients on OPI infusions for 5 days up to 14 days was reduced from 8.7 to 5.9 days (p < 0.001; n = 41, n = 62) and for patients on OPI infusions > = 14 days was reduced from 29.7 to 13.15 days (p = 0.006; n = 9, n = 8) after protocol implementation. The median days on LORAZ for patients on BZD infusions for 5 days up to 14 days was reduced from 9.2 to 5.4 days (p < 0.001; n = 36, n = 50) and for patients on BZD infusions for > = 14 days was reduced from 29.5 to 9.3 days (p = 0.001; n = 8, n = 8). Of note, 4 patients before the protocol were on diazepam. There was no difference observed for METH or LORAZ wean length for patients on 3 to 5 days of infusions that required METH or LORAZ. There was no difference in the number of additional doses of OPI or BZD administered or reports of withdrawal or oversedation between the two groups. No difference in hospital length of stay was observed. Conclusions: A methadone and lorazepam weaning protocol based on patient’s exposure to opioids and benzodiazepines (dose and duration) reduces weaning length.