Alcohol withdrawal syndrome in critically ill patients: protocolized versus nonprotocolized management

Area of Science:

• Critical Care Medicine
• Pharmacology
• Neurology

Background:

• Alcohol withdrawal syndrome (AWS) affects 18-25% of hospitalized patients with alcohol use disorders.
• Symptom-triggered benzodiazepine (BZD) dosing is effective for non-critically ill patients.
• This study evaluates a protocolized approach for critically ill AWS patients.

Purpose of the Study:

• To compare outcomes of critically ill AWS patients treated with a protocolized, symptom-triggered, dose escalation versus a non-protocolized approach.
• To assess the impact of a standardized AWS treatment protocol on patient outcomes.
• To investigate the efficacy of escalating BZD and phenobarbital doses in critically ill AWS patients.

Main Methods:

• Retrospective pre-post study of adult ICU patients with AWS.
• Preintervention cohort (PRE) treated by physician preference; postintervention cohort (POST) received protocolized care.
• POST patients received escalating BZD/phenobarbital doses, titrated to light sedation (RASS 0 to -2).

Main Results:

• POST patients (n=75) had a shorter ICU length of stay (5.2 vs. 9.6 days) and fewer ventilator days (1.3 vs. 5.6 days) compared to PRE patients (n=60).
• POST cohort showed significantly reduced BZD use (93 vs. 319 mg), continuous sedation needs, sedation duration, and intubations for AWS.
• Critically ill patients in the POST group were younger and had lower SOFA scores.

Conclusions:

• Protocolized, symptom-triggered, dose-escalation treatment for AWS in critically ill patients reduces ICU length of stay.
• This approach also decreases mechanical ventilation duration and benzodiazepine requirements.
• Standardized protocols may improve outcomes for critically ill patients with AWS.