SESSION TITLE: Critical Care
SESSION TYPE: Slide Presentations
PRESENTED ON: Monday, March 24, 2014 at 10:45 AM - 11:45 AM
PURPOSE: Patients with severe alcohol withdrawal often require escalating doses of benzodiazepines and intubation with mechanical ventilation which leads to prolonged Intensive Care Unit(ICU) stays. Earlier studies suggest dexmedetomidine is effective in reducing benzodiazepine dosage and autonomic symptoms seen with alcohol withdrawal. We report a retrospective analysis of 53 ICU patients treated for alcohol withdrawal, conducted to compare treatment with benzodiazepine alone to those receiving dexmedetomidine as escalation or substitution therapy.
METHODS: Records from a 17 bed mixed medical-surgical ICU were analyzed from January 2008 to December 2012 for patients treated with alcohol withdrawal. Inclusion criteria was Clinical Institute Withdrawal Scale(CIWA)>14 and received >16mg benzodiazepine over a 4 hour period. Patients were classified into two groups, first receiving benzodiazepine alone and second receiving dexmedetomidine for benzodiazepine refractory withdrawal. The main analysis included length of ICU and hospital stay, vital signs response, incidence of bradycardia, incidence and duration of intubation using t tests and ANOVA
RESULTS: Twenty one out of 23 (91.3%) patients were treated with dexmedetomidine as escalation therapy for benzodiazepine refractory alcohol withdrawal. There was a 49.24% reduction in ICU length of stay after initiation of dexmedetomidine as compared to benzodiazepine(n= 53,p-0.0263) and 25.87% reduction in length of hospital stay(n=53,p-0.31). Analysis of intubated patients from both groups revealed 88.20% reduction in average number of days of intubation(n=22, p-0.0073). There was 19.57% reduction in incidence of intubation in dexmedetomidine group. Heart rate was better controlled following dexmedetomidine initiation, however no significant differences were found in blood pressure control. Eight out of 23 patients on dexmedetomidine developed bradycardia, of which 1 was symptomatic and warranted discontinuation.
CONCLUSIONS: This study suggests that dexmedetomidine therapy for alcohol withdrawal results in reduced ICU stay, reduced hospital stay, reduced days of intubation and blunts hyperadrenergic cardiovascular response. Dexmedetomidine results in increased incidence of bradycardia. Prospective trials are warranted to further evaluate these results.
CLINICAL IMPLICATIONS: Dexmedetomidine might help reduce health care costs by reductions in ICU stay and duration of intubation. Heart rate should be monitored to prevent bradycardia.
DISCLOSURE: The following authors have nothing to disclose: Amit Kachalia, Kinjal Kachalia, Shivaraj Nagalli, Habibur Rahman, Ricardo Lopez, Vincent Rizzo
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