821: Effect of Dexmedetomidine on Icu Length of Stay in the Setting of Severe Alcohol Withdrawal

Landis, Terra; Smoot, Thomas

doi:10.1097/01.ccm.0000631424.36548.29

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“…The studies by Lizotte, Landis, and Stefanilo were excluded from the quantitative synthesis due to concerns regarding internal validity and lack of further available data from their results. [29][30][31] The study by Ludtke and Love were both excluded from the pooled quantitative analysis due to the presence of propofol in the BZD arm. 32,33 Of the cohort studies included in the quantitative synthesis, the studies by Crispo and Collier included those admitted in the ICU for AWS as either primary or secondary diagnosis, 18,34 whereas the studies by Beg, Yavarovich, and VanderWeide, on the contrary, only included in their sample those admitted in the ICU for AWS as the primary diagnosis.…”

Section: Search Resultsmentioning

confidence: 99%

Adjunctive Dexmedetomidine in Alcohol Withdrawal Syndrome: A Systematic Review and Meta-analysis of Retrospective Cohort Studies and Randomized Controlled Trials

et al. 2022

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Objective: To investigate whether dexmedetomidine (DEX), as adjunctive therapy to benzodiazepine (BZD), is superior to BZD alone in critically ill patients with alcohol withdrawal syndrome (AWS). Data Sources: PubMed Central, Cochrane CENTRAL, ClinicalTrials.gov and Google Scholar were used as search databases. Specific keywords and MeSH terms were “dexmedetomidine,” “benzodiazepine,” and “alcohol withdrawal syndrome.” The last search was on September 16, 2022. Study Selection and Data Extraction: Randomized controlled trials (RCTs) and nonrandomized/cohort studies exploring the use of DEX in the management of AWS were included. A total of 12 studies were included in the systematic review and 7 in the meta-analysis. Data Synthesis: The intensive care unit length of stay (ICU LOS) was found to have a mean difference (MD) of 48.06 [37.48, 58.64], P = <0.001 for the cohort subgroup, significantly favoring the DEX arm, but, in contrast, pooled RCT data showed a result of –20.07 [–36.86, –3.28], P = 0.02, a shorter ICU LOS for the DEX arm. Bradycardia and hypotension incidence significantly favored the BZD arm in both subgroups. This study compares the effectiveness of adjunctive DEX in clinical practice and aims to help providers in critical decision-making by compiling and analyzing the best current available evidence of its use in AWS. Conclusions: Based on low to very low level of evidence, adjunctive DEX showed no significant difference for ICU LOS when compared with BZD alone. Pooled randomized trials potentially show a benefit but are similarly limited by their low quality of evidence.

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