High‐dose Intravenous Benzodiazepine

Dill, Curt; Shin, Sang Chul

doi:10.1111/j.1553-2712.2000.tb01087.x

Cited by 6 publications

(2 citation statements)

References 9 publications

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“…Although the incidence of mechanical ventilation was high (47%), it is in agreement with small case series of subjects with benzodiazepine-resistant AWS and in postoperative surgical patients treated with bolusdose therapy of benzodiazepines (9,14). In concert with these studies, the use of mechanical ventilation was associated with a higher ICU LOS and development of nosocomial infections, suggesting that a strategy aimed at reducing the need for mechanical ventilation may improve overall clinical outcomes (14).…”

Section: Discussionsupporting

confidence: 69%

“…Benzodiazepine-resistant AWS, defined as the need for >40 mg of diazepam in 1 hr in one study, is associated with the need for endotracheal intubation and mechanical ventilation for administration of continuous infusion of alternative sedative hypnotics such as barbiturates or propofol, alone or in combination (9 -12). In one study, five of six subjects with benzodiazepine resistance, as defined previously, required intubation (9). Once patients are admitted to the ICU, numerous studies document the course and treatment of surgical patients who develop AWS postoperatively and/or posttrauma (3,13,14).…”

mentioning

confidence: 99%

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A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens*

Gold

Rimal

Nolan

et al. 2007

Critical Care Medicine

154

164

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Objective-Patients with severe alcohol withdrawal and delirium tremens are frequently resistant to standard doses of benzodiazepines. Case reports suggest that these patients have a high incidence of requiring intensive care and many require mechanical ventilation. However, few data exist on treatment strategies and outcomes for these subjects in the medical intensive care unit (ICU). Our goal was a) to describe the outcomes of patients admitted to the medical ICU solely for treatment of severe alcohol withdrawal and b) to determine whether a strategy of escalating doses of benzodiazepines in combination with phenobarbital would improve outcomes. Design-Retrospective cohort study.Setting-Inner-city municipal hospital.Patients-Subjects admitted to the medical ICU solely for the treatment of severe alcohol withdrawal. Interventions-Institution of guidelines emphasizing escalating doses of diazepam in combination with phenobarbital.Measurements and Main Results-Preguideline (n = 54) all subjects were treated with intermittent boluses of diazepam with an average total and maximal individual dose of 248 mg and 32 mg, respectively; 17% were treated with phenobarbital. Forty-seven percent required intubation due to inability to achieve adequate sedation and need for constant infusion of sedative-hypnotics. Intubated subjects had longer length of stay (5.6 vs. 3.4 days; p = .09) and higher incidence of nosocomial pneumonia (42 vs. 21% p = .08). Postguideline (n = 41) there were increases in maximum individual dose of diazepam (32 vs. 86 mg; p = .001), total amount of diazepam (248 vs. 562 mg; p = .001), and phenobarbital use (17 vs. 58%; p = .01). This was associated with a reduction in the need for mechanical ventilation (47 vs. 22%; p = .008), with trends toward reductions in ICU length of stay and nosocomial pneumonia.Conclusions-Patients admitted to a medical ICU solely for treatment of severe alcohol withdrawal have a high incidence of requiring mechanical ventilation. Guidelines emphasizing escalating bolus doses of diazepam, and barbiturates if necessary, significantly reduced the need for mechanical ventilation and showed trends toward reductions in ICU length of stay and nosocomial infections.

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Section: Discussionsupporting

confidence: 69%

mentioning

confidence: 99%