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A Retrospective Analysis of Dexmedetomidine Use for Alcohol Withdrawal Syndrome in Critical Care Patients FREE TO VIEW

Trang Au, MPH; Mark Malesker; Daniel Hilleman; Ryan Walters; Christopher Wichman; Lee Morrow, MS
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Creighton School of Medicine, Omaha, NE

Chest. 2014;146(4_MeetingAbstracts):225A. doi:10.1378/chest.1991617
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SESSION TITLE: Non Pulmonary Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Benzodiazepines (BZP) are the cornerstone of treatment for alcohol withdrawal syndrome (AWS). Critically ill patients often require high doses of BZP. Dexmedetomidine (DEX) is a selective centrally acting alpha-2 adrenergic agonist, and the evidence supporting the use of DEX for AWS is evolving and currently limited to small studies. To the best of our knowledge, this is the largest retrospective cohort study examining the use of DEX for AWS in critically ill patients.

METHODS: Records were reviewed for patients ≥19 years hospitalized for AWS in a 25-bed mixed medical-surgical intensive care unit (ICU) at an academic hospital during 2010-2013. Patients were categorized by treatment with BZP alone or BZP with adjunct DEX (100 per group). Data were collected on patient demographics, chemistry panels, withdrawal assessment, utilization of DEX, lorazepam (LZP) dose requirement, and adverse events. The primary outcome was efficacy (duration of ICU stay) and safety (hypotension, bradycardia) of adjunct DEX compared with BZP alone for treatment of AWS in critically ill patients. Secondary analysis included BZP utilization.

RESULTS: Study subjects were on average 49 years old, male (94%), and Caucasian (70.5%). Baseline characteristics of each group were similar (NS). Compared with controls, patients who received DEX had a reduced ICU length of stay for AWS (3.75±0.22 vs. 4.52±0.23 days, P=0.017) and had more complications (P<0.001). DEX was administered for an average of 2.75±0.18 days, and the dose range was 0.5 ml to 850 ml. Patients who received DEX demonstrated more severe withdrawal days, had more CIWA assessments performed (P=0.003), and increased FiO2 requirements (P=0.002). Longitudinal logistic mixed modeling showed that LZP use was not statistically significant after adjusting for severity of withdrawal. For each additional day of severe withdrawal, there was a 12.5% increase in the odds of requiring a dose of LZP (p<0.0001, 95% CI=8.8%-16.3%).

CONCLUSIONS: This study suggests that DEX when added to standard BZP regimen can effectively reduce length of stay in the ICU for treatment of AWS. DEX appeared to not affect LZP utilization when the data was adjusted for severity of withdrawal. Rather, the number of days with severe withdrawal was the key predictor of LZP administration.

CLINICAL IMPLICATIONS: DEX may be an effective adjunct therapy in reducing length of stay in the ICU for treatment of AWS. The relationship of DEX and BZP utilization needs to be further investigated.

DISCLOSURE: Daniel Hilleman: Consultant fee, speaker bureau, advisory committee, etc.: Bristol-Myers Squibb , Consultant fee, speaker bureau, advisory committee, etc.: Cadence, Consultant fee, speaker bureau, advisory committee, etc.: Pfizer The following authors have nothing to disclose: Trang Au, Mark Malesker, Ryan Walters, Christopher Wichman, Lee Morrow

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