scholarly journals Alcohol withdrawal syndrome in ICU patients: Clinical features, management, and outcome predictors

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261443
Author(s):  
Aliénor Vigouroux ◽  
Charlotte Garret ◽  
Jean-Baptiste Lascarrou ◽  
Maëlle Martin ◽  
Arnaud-Félix Miailhe ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Delirium Tremens ◽  
Multivariable Analysis ◽  
Alcohol Withdrawal Syndrome ◽  
University Hospital ◽  
Icu Patients ◽  
Icu Admission ◽  
Organ Dysfunctions

Background Alcohol withdrawal syndrome (AWS) is a common condition in hospitalized patients, yet its epidemiology in the ICU remains poorly characterized. Methods Retrospective cohort of patients admitted to the Nantes University Hospital ICU between January 1, 2017, and December 31, 2019, and coded for AWS using ICD-10 criteria. The objective of the study was to identify factors associated with complicated hospital stay defined as ICU length of stay ≥7 days or hospital mortality. Results Among 5,641 patients admitted to the ICU during the study period, 246 (4.4%) were coded as having AWS. Among them, 42 had exclusion criteria and 204 were included in the study. The three main reasons for ICU admission were sepsis (29.9%), altered consciousness (29.4%), and seizures (24%). At ICU admission, median Cushman’s score was 6 [4–9] and median SOFA score was 3 [2–6]. Delirium tremens occurred in half the patients, seizures in one fifth and pneumonia in one third. Overall, 48% of patients developed complicated hospital stay, of whom 92.8% stayed in the ICU for ≥7 days, 36.7% received MV for ≥7 days, and 16.3% died during hospital stay. By multivariable analysis, two factors were associated with complicated hospital stay: a higher number of organ dysfunctions at ICU admission was associated with a higher risk of complicated hospital stay (OR, 1.18; 95CI, 1.05–1.32, P = 0.005), whereas ICU admission for seizures was associated with a lower risk of complicated hospital stay (OR, 0.14; 95%CI, 0.026–0.80; P = 0.026). Conclusions AWS in ICU patients chiefly affects young adults and is often associated with additional factors such as sepsis, trauma, or surgery. Half the patients experienced an extended ICU stay or death during the hospital stay. The likelihood of developing complicated hospital stay relied on the reason for ICU admission and the number of organ dysfunctions at ICU admission.

scholarly journals Delirium tremens: early diagnosis and intensive care guidelines. Review

2020 ◽  
pp. 53-65
Author(s):  
A. Ye Muronov
Keyword(s):  
Intensive Care ◽  
Alcohol Consumption ◽  
Early Diagnosis ◽  
Hospital Stay ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Delirium Tremens ◽  
Length Of Hospital Stay ◽  
Alcohol Withdrawal Syndrome ◽  
Care Guidelines

Alcoholic delirium is a formidable complication of severe alcohol withdrawal syndrome. It is often formed in patients of hospitals and departments of anesthesiology and intensive care, as a result of the forced cessation of alcohol consumption. Its formation is associated with an increase in the length of hospital stay and mortality. The review discusses modern approaches to the diagnosis, especially early, of this condition, its intensive care and methods of non-drug correction.

scholarly journals Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tessa L. Steel ◽  
Shewit P. Giovanni ◽  
Sarah C. Katsandres ◽  
Shawn M. Cohen ◽  
Kevin B. Stephenson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome ◽  
Patient Characteristics ◽  
Response To Treatment ◽  
Alternative Measure ◽  
Icu Patients ◽  
Verbal Responses

Abstract Background The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is commonly used in hospitals to titrate medications for alcohol withdrawal syndrome (AWS), but may be difficult to apply to intensive care unit (ICU) patients who are too sick or otherwise unable to communicate. Objectives To evaluate the frequency of CIWA-Ar monitoring among ICU patients with AWS and variation in CIWA-Ar monitoring across patient demographic and clinical characteristics. Methods The study included all adults admitted to an ICU in 2017 after treatment for AWS in the Emergency Department of an academic hospital that standardly uses the CIWA-Ar to assess AWS severity and response to treatment. Demographic and clinical data, including Richmond Agitation-Sedation Scale (RASS) assessments (an alternative measure of agitation/sedation), were obtained via chart review. Associations between patient characteristics and CIWA-Ar monitoring were tested using logistic regression. Results After treatment for AWS, only 56% (n = 54/97) of ICU patients were evaluated using the CIWA-Ar; 94% of patients had a documented RASS assessment (n = 91/97). Patients were significantly less likely to receive CIWA-Ar monitoring if they were intubated or identified as Black. Conclusions CIWA-Ar monitoring was used inconsistently in ICU patients with AWS and completed less often in those who were intubated or identified as Black. These hypothesis-generating findings raise questions about the utility of the CIWA-Ar in ICU settings. Future studies should assess alternative measures for titrating AWS medications in the ICU that do not require verbal responses from patients and further explore the association of race with AWS monitoring.

P0227 RISK FACTORS FOR DELIRIUM TREMENS IN PATIENTS WITH ALCOHOL WITHDRAWAL SYNDROME IN A HOSPITAL SETTING

2009 ◽  
Vol 20 ◽  
pp. S81
Author(s):  
Rafael Monte ◽  
Ramón Rabuñal ◽  
Milagros Peña ◽  
Hugo López ◽  
Ana Pazos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Delirium Tremens ◽  
Hospital Setting ◽  
Alcohol Withdrawal Syndrome

scholarly journals Patient Outcomes Associated With Phenobarbital Use With or Without Benzodiazepines for Alcohol Withdrawal Syndrome: A Systematic Review

2017 ◽  
Vol 52 (9) ◽  
pp. 607-616 ◽  
Author(s):  
Drayton A. Hammond ◽  
Jordan M. Rowe ◽  
Adrian Wong ◽  
Tessa L. Wiley ◽  
Kristen C. Lee ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Observational Studies ◽  
Alcohol Withdrawal Syndrome ◽  
Hospital Length Of Stay ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Icu Admission

Purpose: Benzodiazepines are the drug of choice for alcohol withdrawal syndrome (AWS); however, phenobarbital is an alternative agent used with or without concomitant benzodiazepine therapy. In this systematic review, we evaluate patient outcomes with phenobarbital for AWS. Methods: Medline, Cochrane Library, and Scopus were searched from 1950 through February 2017 for controlled trials and observational studies using [“phenobarbital” or “barbiturate”] and [“alcohol withdrawal” or “delirium tremens.”] Risk of bias was assessed using tools recommended by National Heart, Lung, and Blood Institute. Results: From 294 nonduplicative articles, 4 controlled trials and 5 observational studies (n = 720) for AWS of any severity were included. Studies were of good quality (n = 2), fair (n = 4), and poor (n = 3). In 6 studies describing phenobarbital without concomitant benzodiazepine therapy, phenobarbital decreased AWS symptoms ( P < .00001) and displayed similar rates of treatment failure versus comparator therapies (38% vs 29%). A study with 2 cohorts showed similar rates of intensive care unit (ICU) admission (phenobarbital: 16% and 9% vs benzodiazepine: 14%) and hospital length of stay (phenobarbital: 5.85 and 5.30 days vs benzodiazepine: 6.64 days). In 4 studies describing phenobarbital with concomitant benzodiazepine therapy, phenobarbital groups had similar ICU admission rates (8% vs 25%), decreased mechanical ventilation (21.9% vs 47.3%), decreased benzodiazepine requirements by 50% to 90%, and similar ICU and hospital lengths of stay and AWS symptom resolution versus comparator groups. Adverse effects with phenobarbital, including dizziness and drowsiness, rarely occurred. Conclusion: Phenobarbital, with or without concomitant benzodiazepines, may provide similar or improved outcomes when compared with alternative therapies, including benzodiazepines alone.

Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management

2016 ◽  
Vol 36 (1) ◽  
pp. 28-38 ◽  
Author(s):  
Lynsey J. Sutton ◽  
Annemarie Jutel
Keyword(s):  
At Risk ◽  
Alcohol Consumption ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Delirium Tremens ◽  
Alcohol Withdrawal Syndrome ◽  
Rapid Identification ◽  
Severe Withdrawal

Management of alcohol withdrawal in critically ill patients is a challenge. The alcohol consumption histories of intensive care patients are often incomplete, limiting identification of patients with alcohol use disorders. Abrupt cessation of alcohol places these patients at risk for alcohol withdrawal syndrome. Typically benzodiazepines are used as first-line therapy to manage alcohol withdrawal. However, if patients progress to more severe withdrawal or delirium tremens, extra adjunctive medications in addition to benzodiazepines may be required. Sedation and mechanical ventilation may also be necessary. Withdrawal assessment scales such as the Clinical Institute of Withdrawal Assessment are of limited use in these patients. Instead, general sedation-agitation scales and delirium detection tools have been used. The important facets of care are the rapid identification of at-risk patients through histories of alcohol consumption, management with combination therapies, and ongoing diligent assessment and evaluation. (Critical Care Nurse. 2016;36[1]:28–39)

Lorazepam versus chlordiazepoxide for the treatment of alcohol withdrawal syndrome and prevention of delirium tremens in general medicine ward patients

Alcohol ◽  
2019 ◽  
Vol 81 ◽  
pp. 56-60
Author(s):  
Katherine L. March ◽  
Jennifer D. Twilla ◽  
Anne B. Reaves ◽  
Timothy H. Self ◽  
Melissa M. Slayton ◽  
...  
Keyword(s):  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Delirium Tremens ◽  
General Medicine ◽  
Alcohol Withdrawal Syndrome

Treatment of Acute Alcohol Withdrawal Syndrome with Carbamazepine: A Double-Blind Comparison with Tiapride

1982 ◽  
Vol 10 (3) ◽  
pp. 160-165 ◽  
Author(s):  
R Agricola ◽  
M Mazzarino ◽  
R Urani ◽  
V Gallo ◽  
E Grossi
Keyword(s):  
Visual Analogue Scale ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Analogue Scale ◽  
Clinical Effect ◽  
Delirium Tremens ◽  
Alcohol Withdrawal Syndrome ◽  
Double Blind ◽  
Significant Difference ◽  
Blind Comparison

A double-blind, randomized trial is described which was designed to compare the clinical effect of 600 mg daily of carbamazepine (Tegretol®) and of tiapride (Sereprile®) in hospitalized patients with pre-delirium tremens. Physicians' assessment of patients' progress was made following 2, 4 and 7 days of treatment. Of the sixty patients admitted to the study, five dropped out for various reasons, leaving fifty-five patients who completed the study. Both drugs were effective in the treatment of alcohol withdrawal symptoms; no significant difference was found between the two treatments with respect to total symptoms' score and visual analogue scale assessment. Carbamazepine gave faster relief of symptoms and demonstrated a preferential action on symptoms like fear and hallucinations. No case of delirium tremens was observed in those patients who completed the trial.

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