The points raised by Dr Pektezel and collaborators are interesting and would indeed complement our pilot study. In our entry criteria, we were looking for patients who were exposed to opioids to a degree sufficient to be at risk of iatrogenic withdrawal. In this era of intensive care unit (ICU) liberation whereby analgesia is optimized, sedation is minimized, and a ventilator weaning protocol is implemented, the population most at risk of iatrogenic withdrawal in our 2 units was the trauma population. A significant portion of our patients had polytrauma and some had combined polytrauma and mild traumatic brain injury (TBI). Unfortunately, only 1 patient in our study was admitted with a nervous system disorder, representing 12% of our 8 patients who had iatrogenic withdrawal syndrome develop.1,2  No conclusion can be drawn from that sole patient.

We fully agree with...

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