The online version of this article (doi:10.1186/2110-5820-2-12) contains supplementary material, which is available to authorized users.
The authors report no receipt of funding for this study and no potential conflicts of interest with any companies or services whose products are discussed in this article.
SGR was the lead author of this study and contributed to study design, data collection, statistical analysis, and manuscript preparation/review. He also guarantees, to the best of his knowledge, the factual and statistical validity of the information contained herein. CRW contributed to study design, application for IRB approval, and manuscript preparation and review. HP contributed to patient selection and manuscript review. SJ contributed to study design and manuscript review. AFB was the principal investigator of this study and involved in oversight of study design, data collection and analysis, and manuscript preparation/review. All authors read and approved the final manuscript.
Patients undergoing alcohol withdrawal in the intensive care unit (ICU) often require escalating doses of benzodiazepines and not uncommonly require intubation and mechanical ventilation for airway protection. This may lead to complications and prolonged ICU stays. Experimental studies and single case reports suggest the α2-agonist dexmedetomidine is effective in managing the autonomic symptoms seen with alcohol withdrawal. We report a retrospective analysis of 20 ICU patients treated with dexmedetomidine for benzodiazepine-refractory alcohol withdrawal.
Records from a 23-bed mixed medical-surgical ICU were abstracted from November 2008 to November 2010 for patients who received dexmedetomidine for alcohol withdrawal. The main analysis compared alcohol withdrawal severity scores and medication doses for 24 h before dexmedetomidine therapy with values during the first 24 h of dexmedetomidine therapy.
There was a 61.5% reduction in benzodiazepine dosing after initiation of dexmedetomidine (n = 17; p < 0. 001) and a 21.1% reduction in alcohol withdrawal severity score (n = 11; p = .015). Patients experienced less tachycardia and systolic hypertension following dexmedetomidine initiation. One patient out of 20 required intubation. A serious adverse effect occurred in one patient, in whom dexmedetomidine was discontinued for two 9-second asystolic pauses noted on telemetry.
This observational study suggests that dexmedetomidine therapy for severe alcohol withdrawal is associated with substantially reduced benzodiazepine dosing, a decrease in alcohol withdrawal scoring and blunted hyperadrenergic cardiovascular response to ethanol abstinence. In this series, there was a low rate of mechanical ventilation associated with the above strategy. One of 20 patients suffered two 9-second asystolic pauses, which did not recur after dexmedetomidine discontinuation. Prospective trials are warranted to compare adjunct treatment with dexmedetomidine versus standard benzodiazepine therapy.
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Hospira Inc - Precedex®. (dexmedetomidine hydrochloride injection). http://www.precedex.com
- Dexmedetomidine as adjunct treatment for severe alcohol withdrawal in the ICU
Samuel G Rayner
Craig R Weinert
Alain F Broccard
- Springer Paris
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