Iatrogenic withdrawal syndrome (IWS) is a frequently encountered complication in pediatric intensive care units. Despite the publication of the 2022 recommendations, many questions about this topic remain unanswered. The aim of this paper is to present recent advances in the literature since the guidelines were published in an effort to address these questions. group of multidisciplinary experts in analgesia and sedation was convened by two project coordinators. Two virtual meetings were held to identify the unanswered questions on IWS in the PICU, reaching an agreement on five topics that informed the literature search strategy. A literature review was performed to identify papers published from January 1, 2020 to 30 June, 2025. Each publication was selected at the title and abstract level by the coordinators, and the reference lists of the selected papers were searched for completeness. Where the literature search didn’t yield results, the panel of experts was consulted. We selected the following unanswered questions (1) which is the definition of IWS? (2) Which are the risk factors for IWS? (3) Is the prevention of IWS possible? (4) Which is the most effective treatment of IWS? (5) Which new aspects should be investigated? A total of 311 titles were identified through the search strategy; 27 papers were finally included. Many unanswered questions remain. Further research should focus on the optimal weaning strategy and on the treatment of IWS.
Amigoni et al. (2026) studied this question.