Retrospective Review of Critically Ill Patients Experiencing Alcohol withdrawal: Dexmedetomidine versus Propofol and/or Lorazepam Continuous Infusions

Abstract

Background: Alcohol withdrawal symptoms can be difficult to manage and may lead to an intensive care unit (ICU) admission. Patients experiencing severe alcohol withdrawal often require high doses of sedatives, which can lead to respiratory depression and the need for endotracheal intubation. Dexmedetomidine, an alpha-2 adrenoreceptor agonist, provides adequate sedation with little effect on respiratory function when compared to other sedatives. Objective: To evaluate sedation with a continuous infusion of dexmedetomidine versus propofol and/or lorazepam in critically ill patients experiencing alcohol withdrawal. Methods: A retrospective chart review was conducted on ICU admissions between March 2002 and April 2009 for alcohol withdrawal patients who necessitated treatment with a continuous infusion of dexmedetomidine, propofol, and/or lorazepam. Primary outcomes included the incidence of mechanical ventilation, length of mechanical ventilation (if applicable), and ICU and hospital length of stay. Results: Fifteen patients were treated with a continuous infusion of dexmedetomidine, and 17 were treated with an infusion of propofol and/or lorazepam. Two patients (13.3%) required intubation and mechanical ventilation in the dexmedetomidine group versus 10 (58.8%) in the propofol and/or lorazepam group (P = .006). Length of stay in the ICU was 53 hours for patients treated with dexmedetomidine versus 114.9 hours in the propofol and/or lorazepam group (P = .016). Hospital length of stay was less for the dexmedetomidine group, 135.8 hours versus 241.1 hours in the propofol and/or lorazepam group (P = .008). Conclusions: Dexmedetomidine use was associated with a decrease in the incidence of endotracheal intubation when used to sedate patients experiencing alcohol withdrawal. Patients transferred to a lower level of care faster and were discharged from the hospital sooner when treated with dexmedetomidine.

Dexmedetomidine for Alcohol Withdrawal Syndrome

“…[14][15][16][17][18][19][20][21] Mueller et al 18 conducted a randomized controlled trial involving 24 patients to evaluate dexmedetomidine as adjunctive therapy to lorazepam in patients with severe AWS. Patients were randomized 2:1 to either placebo or dexmedetomidine.…”

“…No difference between groups in the composite endpoint of rate of respiratory distress requiring intubation or alcohol withdrawal seizures (3 patients in the benzodiazepine group vs 2 patients in the dexmedetomidine group) Ludtke et al 17 Retrospective cohort study Dexmedetomidine (n = 15) or continuous infusion propofol and/or lorazepam (n = 17)…”

Review of adjunctive dexmedetomidine in the management of severe acute alcohol withdrawal syndrome

“…Dexmedetomidine has been evaluated as a sedative in patients with alcohol abuse prior to active AWS, demonstrating variable effectiveness (20,21). Available literature regarding its use for management of active AWS includes case reports and series, retrospective analyses and a randomized controlled trial (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). The purpose of this review is to provide current findings of published literature regarding the efficacy and safety of this adjunctive therapy in the management of AWS.…”

Therapeutic Approach to the Critically Poisoned Patient

“…However, this is controversial and one randomized, doubleblind, placebo-controlled pilot study did not find that it improved tolerance to noninvasive ventilation [184]. Recent trials in patients with sedativehypnotic withdrawal indicate that dexmedetomidine may be a useful adjunct; however, more studies are required to determine its safety and efficacy in this population [185,186]. Dexmedetomidine was administered to 22 poisoned patients who were intubated in an ICU [187].…”