Alcohol withdrawal syndromes in the intensive care unit

Abstract

This article reviews the pathophysiology, diagnosis, and treatment of alcohol withdrawal syndromes in the intensive care unit as well as the literature on the optimal pharmacologic strategies for treatment of alcohol withdrawal syndromes in the critically ill. Treatment of alcohol withdrawal in the intensive care unit mirrors that of the general acute care wards and detoxification centers. In addition to adequate supportive care, benzodiazepines administered in a symptom-triggered fashion, guided by the Clinical Institute Withdrawal Assessment of Alcohol scale, revised (CIWA-Ar), still seem to be the optimal strategy in the intensive care unit. In cases of benzodiazepine resistance, numerous options are available, including high individual doses of benzodiazepines, barbiturates, and propofol. Intensivists should be familiar with the diagnosis and treatment strategies for alcohol withdrawal syndromes in the intensive care unit.

Treatment of Alcohol Withdrawal Syndrome with and without Dexmedetomidine

“…There is also growing concern that benzodiazepines may worsen delirium and the mortality rate in hospitalized patients; therefore, recent guidelines recommend against using benzodiazepines as first-line sedatives in critical illness. [4][5][6][7] Prior studies suggest that dexmedetomidine-an intravenous central-acting a 2 -adrenergic agonist that effectively reduces anxiety among critically ill patients-is being used in patients with severe alcohol withdrawal. [8][9][10][11][12][13] However, the evidence supporting its use is limited, and it has not received approval from the US Food and Drug Administration for this indication.…”

Add on dexmedetomidine in the treatment of severe alcohol withdrawal in a patient of emergency laparotomy

“…3,5 AWS can manifest between 24 to 96 hours after abstaining from alcohol. It has been reported in literature in postoperative care.…”

“…3,5 It was approved by FDA in 1999 for sedation in mechanically ventilated Patients in ICU and for procedural sedation in non-intubated patients for maximal 24 hours. Dexmedetomidine produces a state of cooperative sedation and has an anesthetic, anxiolytic, analgesic and sympatholytic properties.…”

Identification and management of alcohol dependence and withdrawal in alcoholic liver disease

“…A score of <10 does not usually require medication-assisted treatment of withdrawal. 7 A score of 10-15 indicates moderate withdrawal that may require medication. A score of >15 suggests severe withdrawal requiring medication-assisted treatment.…”