Opioids Withdrawal Syndrome in Critically Ill Patients: a Multicenter Prospective Cohort Study

Inclusion Criteria: * intermittent use or continuous infusion opioids for at least 96 hours Exclusion Criteria: * Patient and/or relatives unable to communicate in French or English * Patients unable to communicate (consent form and evaluation) * Patient deaf without appropriate hearing aid * Patients unable to communicate (consent form and evaluation) * Imminent and predictable death according to medical team * Severe brain injury, defined as Glasgow Coma Scale (GCS) score of 8 or less at ICU admission * Moderate brain injury, defined as GCS between 9 and 12, with elevated intracranial pressure (ICP \> 20 mm Hg) who requires ICP monitoring and osmotherapy * Major confounding factors for withdrawal syndrome by causing shivering, sympathetic drive and autonomic disorders * Underlying active neurological condition (status epilepticus, encephalopathy, hypoxia) * Neurological problems are covariates, which would make the assessment of sedation or IWS difficult Patient previously included in the study at any of the two hospitals (readmission to the ICU at a later date during the period of recruitment for the study, limiting to 1 weaning episode per patient) * Thoracic and cervical spinal cord injury * Adrenergic response to pain will be difficult to assess * Unable to assess validated tool: DSM-V, RASS, CAM-ICU * Narcotic * If the underlying neurological condition resolves within the 96 hours, the patient may be included in the study * Substance abuse prior to ICU admission (28…