Alcohol, Nicotine, and Iatrogenic Withdrawals in the ICU

Awissi, Don-Kelena; Lebrun, Geneviève; Fagnan, Mylène; Skrobik, Yoanna

doi:10.1097/ccm.0b013e3182a16919

Cited by 58 publications

(51 citation statements)

References 124 publications

(104 reference statements)

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“…37 Although no evidence indicates that one benzodiazepine is better than another, the choice of a particular drug should be tailored to the patient. 39 For example, rapid-acting benzodiazepines such as diazepam, lorazepam, and alprazolam may be more appropriate in patients when rapid symptom control is needed. 36 Conversely, agents such as chlordiazepoxide and diazepam may be more effective in providing a smoother detoxification course and reducing rebound withdrawal symptoms.…”

Section: Benzodiazepinesmentioning

confidence: 99%

“…The active metabolite may accumulate in the liver in patients with hepatic disease if the dose of the drug is not adjusted. 39 Instead, alprazolam and lorazepam may be more appropriate for patients with liver dysfunction. 36 Unfortunately, recommendations and guidelines on the optimum choice and dose of drug for critically ill patients with AWS remain limited.…”

Section: Benzodiazepinesmentioning

confidence: 99%

“…36 Unfortunately, recommendations and guidelines on the optimum choice and dose of drug for critically ill patients with AWS remain limited. 39 However, administration of benzodiazepines via the intravenous route may be preferable in the ICU because of the rapid onset of action and more predictable bioavailability. 39 Symptom-Triggered Therapy and the CIWA-ar Scale Administration of benzodiazepines according to symptom-triggered therapy in combination with an alcohol withdrawal assessment scale has been superior to fixed dose scheduling in a variety of community and hospital settings.…”

Section: Benzodiazepinesmentioning

confidence: 99%

“…39 However, administration of benzodiazepines via the intravenous route may be preferable in the ICU because of the rapid onset of action and more predictable bioavailability. 39 Symptom-Triggered Therapy and the CIWA-ar Scale Administration of benzodiazepines according to symptom-triggered therapy in combination with an alcohol withdrawal assessment scale has been superior to fixed dose scheduling in a variety of community and hospital settings. [40][41][42][43] Evaluations 44-46 of symptomtriggered therapy in the ICU have predominantly focused on the use of the CIWA-ar scale.…”

Section: Benzodiazepinesmentioning

confidence: 99%

“…A score less than 8 indicates mild withdrawal; moderate withdrawal is indicated by scores of 8 to 15, and scores greater than 20 indicate severe withdrawal. 39 Typically, drug therapy is started in patients who have a score greater than 8. Despite widespread use of the CIWA-ar scale in the ICU, only 4 randomized clinical studies [44][45][46][47] and 1 retrospective cohort study 48 that included use of the scale in patients with AWS have been published.…”

Section: 10mentioning

confidence: 99%

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Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management

Sutton-Smith

Jutel

2016

Critical Care Nurse

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Management of alcohol withdrawal in critically ill patients is a challenge. The alcohol consumption histories of intensive care patients are often incomplete, limiting identification of patients with alcohol use disorders. Abrupt cessation of alcohol places these patients at risk for alcohol withdrawal syndrome. Typically benzodiazepines are used as first-line therapy to manage alcohol withdrawal. However, if patients progress to more severe withdrawal or delirium tremens, extra adjunctive medications in addition to benzodiazepines may be required. Sedation and mechanical ventilation may also be necessary. Withdrawal assessment scales such as the Clinical Institute of Withdrawal Assessment are of limited use in these patients. Instead, general sedation-agitation scales and delirium detection tools have been used. The important facets of care are the rapid identification of at-risk patients through histories of alcohol consumption, management with combination therapies, and ongoing diligent assessment and evaluation. (Critical Care Nurse. 2016;36[1]:28–39)

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Section: Benzodiazepinesmentioning

confidence: 99%

Section: Benzodiazepinesmentioning

confidence: 99%

Section: Benzodiazepinesmentioning

confidence: 99%

Section: Benzodiazepinesmentioning

confidence: 99%

Section: 10mentioning

confidence: 99%

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Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management

Sutton-Smith

Jutel

2016

Critical Care Nurse

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Part II: Case series: Acute agitation, delirium, and sleep management

Smith

2024

J Am Coll Clin Pharm

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LEARNING OBJECTIVES1. Apply bedside clinical assessment tools to detect pain, agitation, and delirium in the critically ill patient.2. Design an evidence-based pharmacotherapy regimen for agitation in the critically ill patient.3. Evaluate pharmacologic approaches for prevention and management of ICU delirium.4. Assess therapeutic approaches to improve sleep quality in critically ill patients. 5. Develop a population-based approach for agitation, delirium, and sleep disturbance management in the ICU.

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Management of Acute Alcohol Withdrawal Syndrome in Critically Ill Patients

et al. 2016

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Approximately 16-31% of patients in the intensive care unit (ICU) have an alcohol use disorder and are at risk for developing alcohol withdrawal syndrome (AWS). Patients admitted to the ICU with AWS have an increased hospital and ICU length of stay, longer duration of mechanical ventilation, higher costs, and increased mortality compared with those admitted without an alcohol-related disorder. Despite the high prevalence of AWS among ICU patients, no guidelines for the recognition or management of AWS or delirium tremens in the critically ill currently exist, leading to tremendous variability in clinical practice. Goals of care should include immediate management of dehydration, nutritional deficits, and electrolyte derangements; relief of withdrawal symptoms; prevention of progression of symptoms; and treatment of comorbid illnesses. Symptom-triggered treatment of AWS with γ-aminobutyric acid receptor agonists is the cornerstone of therapy. Benzodiazepines (BZDs) are most studied and are often the preferred first-line agents due to their efficacy and safety profile. However, controversy still exists as to who should receive treatment, how to administer BZDs, and which BZD to use. Although most patients with AWS respond to usual doses of BZDs, ICU clinicians are challenged with managing BZD-resistant patients. Recent literature has shown that using an early multimodal approach to managing BZD-resistant patients appears beneficial in rapidly improving symptoms. This review highlights the results of recent promising studies published between 2011 and 2015 evaluating adjunctive therapies for BZD-resistant alcohol withdrawal such as antiepileptics, baclofen, dexmedetomidine, ethanol, ketamine, phenobarbital, propofol, and ketamine. We provide guidance on the places in therapy for select agents for management of critically ill patients in the presence of AWS.

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Alcohol, Nicotine, and Iatrogenic Withdrawals in the ICU

Cited by 58 publications

References 124 publications

Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management

Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management

Part II: Case series: Acute agitation, delirium, and sleep management

Management of Acute Alcohol Withdrawal Syndrome in Critically Ill Patients

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