Open Access Research

Dexmedetomidine as adjunct treatment for severe alcohol withdrawal in the ICU

Samuel G Rayner1*, Craig R Weinert2, Helen Peng3, Stacy Jepsen3, Alain F Broccard4 and Study Institution5

Author Affiliations

1 University of Minnesota Medical School, 1803 E John Street Seattle, Seattle, WA 98112, USA

2 Division of Pulmonary, Allergy, and Sleep Medicine; Fairview-Southdale Hospital, University of Minnesota, Minneapolis, MN, USA

3 Fairview-Southdale Hospital, 6401 France Ave. S., Edina, MN, 55435, USA

4 Division of Pulmonary, Allergy, and Sleep Medicine; Fairview-Southdale HospitalUniversity of Minnesota, University of Minnesota, Minneapolis, MN, USA

5 Fairview-Southdale Hospital, 6401 France Ave. S. Edina, Minnesota, MN, 55435, USA

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Annals of Intensive Care 2012, 2:12  doi:10.1186/2110-5820-2-12

Published: 23 May 2012

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords:
Alcohol withdrawal delirium; Alcohol withdrawal syndrome; Dexmedetomidine; Intensive care; Critical care; Benzodiazepines