Incidence and Management of Sedative Withdrawal Syndrome in a Tertiary Pediatric Intensive Care Unit: A Single-Center Retrospective Study

다국어 초록 (Multilingual Abstract)

Background: Sedative withdrawal syndrome (SWS) in the pediatric intensive care unit (PICU) can lead to vital sign instability and adversely affect clinical outcomes. In pediatric patients, the diagnosis of SWS is particularly challenging due to immature metabolic and neurological development. This study aimed to determine the incidence and risk factors of SWS and to describe current pharmacologic management practices in a tertiary PICU. Methods: From March 2022 to February 2025, we retrospectively reviewed the electronic medical records of pediatric patients admitted to the PICU who required mechanical ventilation and received a continuous intravenous infusion of midazolam or ketamine for sedation lasting more than 24 hours. Results: Among the 197 patients included, 44 patients (22.3%) developed SWS. Compared with the non-SWS group, the SWS group had longer PICU length of stay and sedative administration duration. For midazolam, sufentanil, and dexmedetomidine, the SWS group showed longer total infusion duration, higher maximum doses, and greater cumulative doses before tapering. Tapering for midazolam and sufentanil was initiated later in the SWS group. In contrast, ketamine-related variables did not differ between the two groups. In multivariable analysis, the cumulative dose of midazolam before tapering was the only independent risk factor for SWS. Clonidine and dexmedetomidine combination therapy was the most frequently used pharmacologic intervention for controlling SWS (22.7%). Conclusions: The cumulative midazolam dose before tapering initiation was the only independent risk factor for SWS. In PICU patients receiving prolonged or high cumulative doses of midazolam, monitoring for the occurrence of SWS should be considered.