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

Abstract

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.

Dexmedetomidina en la supresión etílica: una revisión sistemática y metaanálisis

“…En la revisión sistemática y metaanálisis de Polintan et al 16 se encontró que la duración de la estancia hospitalaria tenía una MD de 53.18 (18.47-87.89), p < 0.003, para el subgrupo de cohorte, mostrando una diferencia significativa en favor de la terapia estándar con benzodiacepinas, contrario al grupo de estudios clínicos aleatorizados, en los que se favorece significativamente a la dexmedetomidina. El uso de dexmedetomidina se asocia con un menor uso de benzodiazepinas en comparación con la terapia con benzodiazepina sola, como ha sido sustentado previamente en la literatura.…”

Comparative efficacy of various pharmacologic treatments for alcohol withdrawal syndrome: a systematic review and network meta-analysis

“…Therefore, dexmedetomidine can sedate without respiratory failure and is considered a promising clinical adjuvant for the treatment of AWS (Szumita et al ., 2007), especially for patients with severe AWS treated in the ICU. In a meta-analysis, Polintan et al . (2023).…”

“…To the best of our knowledge, no previous systematic review and network meta-analysis (NMA) have comprehensively compared multiple drugs and drug combinations for the treatment of AWS. While there have been individual meta-analyses (Rojo-Mira et al ., 2022; Polintan et al ., 2023) conducted on specific interventions or comparisons with BZDs, our study aims to provide a more comprehensive evaluation of various treatment options available for AWS. By including a wide range of interventions and utilizing NMA, we are able to indirectly compare treatments that have not been directly compared in head-to-head clinical trials.…”