Dexmedetomidine as adjunctive therapy in alcohol withdrawal syndrome patients in an intensive care unit

Purpose: To describe the use of dexmedetomidine (DEX) in combination with benzodiazepines for treatment of alcohol withdrawal symptoms and to identify factors associated with treatment success versus failure.

Methods: A retrospective review of medical records was used to identify subjects admitted to Northwest Texas Hospital critical care units between October 1, 2009 and February 29, 2012 who were diagnosed with alcohol withdrawal syndrome (AWS), delirium tremens, alcohol-related seizures or hallucinations and treated with DEX.  The study included patients > 18 years of age with an ICU length of stay > 24 hours. Subjects requiring mechanical ventilation prior to DEX infusion were excluded from the primary outcome. Treatment success with DEX was defined as avoidance of mechanical ventilation. Factors assessed were quantity of benzodiazepines before and after DEX, starting, bolus and total dose of DEX administered.

Results: 39 subjects met inclusion criteria. Two subjects received DEX for surgical procedures only and were excluded from analysis. Subjects were primarily white (84.6%) males (84.6%) with an average age of 45.0 + 10.9 years, and median ICU length of stay of 7 days (range 1-30). Eleven subjects were intubated prior to initiation of DEX. The 28 remaining subjects were included in the primary outcome analysis. Of these, 89.2% were successfully treated with DEX and avoided mechanical ventilation. Quantity of benzodiazepines prior to initiation of DEX and method of DEX dosing varied considerably among subjects. Hypotension (SBP<90) and bradycardia (HR<50) were the most commonly observed adverse effects (35.9% and 12.8%, respectively). Discontinuation of DEX was required in 1 subject and 3 subjects required vasopressors after initiation of DEX.

Conclusion: Use of DEX in combination with benzodiazepines for management of AWS may help prevent mechanical ventilation. Further prospective studies with a larger sample size are needed to confirm these findings and determine optimal dosing strategies.