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Intensive Care Medicine

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01.01.2013 | Review

Alcohol withdrawal and delirium tremens in the critically ill: a systematic review and commentary

verfasst von: Don-Kelena Awissi, Genevieve Lebrun, Douglas B. Coursin, Richard R. Riker, Yoanna Skrobik

Erschienen in: Intensive Care Medicine | Ausgabe 1/2013

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Abstract

Introduction

Alcohol withdrawal is common among intensive care unit (ICU) patients, but no current practice guidelines exist. We reviewed published manuscripts for prevalence, risk factors, screening tools, prophylactic and treatment strategies, and outcomes for alcohol withdrawal syndrome (AWS) and delirium tremens (DT) in the critically ill.

Methods

The following databases: PubMed, MEDLINE, Embase, Cochrane Database of Systematic Reviews and Central Register of Controlled Trials, CINAHL, Scopus, Web of Knowledge, pain, anxiety and delirium (PAD) Guidelines REFWORKS, International Pharmaceutical Abstracts and references for published papers were searched. Publications with high or moderate Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Oxford levels of evidence were included.

Results

Reported AWS rates range from <1 % in ‘all ICU comers’ to 60 % in highly selected alcohol-dependent ICU patients. Alcohol dependence and a history of withdrawal are significant risk factors for AWS occurrence. No screening tools for withdrawal have been validated in the ICU. The benefit of alcohol withdrawal prophylaxis is unproven, and proposed regimens appear equivalent. Early and aggressive titration of medication guided by symptoms is the only feature associated with improved treatment outcome.

Conclusions

Treatment of AWS is associated with higher ICU complication rates and resource utilization. The optimal means of identification, prevention and treatment of AWS in order to establish evidence-based guidelines remain to be determined.

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Titel: Alcohol withdrawal and delirium tremens in the critically ill: a systematic review and commentary
verfasst von: Don-Kelena Awissi
Genevieve Lebrun
Douglas B. Coursin
Richard R. Riker
Yoanna Skrobik
Publikationsdatum: 01.01.2013
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 1/2013
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-012-2758-y

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