Erin N Frazee1, Heather A Personett2, Jonathan G Leung2, Sarah Nelson2, Ross A Dierkhising3, Philippe R Bauer4. 1. Hospital Pharmacy Services, Mayo Clinic, Rochester, MN. Electronic address: frazee.erin@mayo.edu. 2. Hospital Pharmacy Services, Mayo Clinic, Rochester, MN. 3. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN. 4. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Abstract
PURPOSE: Although benzodiazepines are first-line drugs for alcohol withdrawal syndrome (AWS), rapidly escalating doses may offer little additional benefit and increase complications. The purpose of this study was to evaluate dexmedetomidine's impact on benzodiazepine requirements and hemodynamics in AWS. MATERIALS AND METHODS: This retrospective case series evaluated 33 critically ill adults with a primary diagnosis of AWS from 2006 to 2012 at an academic medical center. RESULTS: Dexmedetomidine began a median (interquartile range) of 11 (2, 32) hours into intensive care unit admission and was titrated to an infusion rate of 0.7 (0.4, 0.7) μg kg(-1) h(-1) to achieve the desired depth of sedation. In the 12 hours after dexmedetomidine began, patients experienced a 20-mg reduction in median cumulative benzodiazepine dose used (P < .001), a 14-mm Hg lower mean arterial pressure (P = .03), and a 17-beats/min reduction in median heart rate (P < .001). Four (12%) patients experienced hypotension (systolic blood pressure <80 mm Hg) during therapy, and there were no cases of bradycardia (heart rate <40 beats/min). CONCLUSION: Dexmedetomidine decreased benzodiazepine requirements and improved the overall hemodynamic profile of patients with severe AWS. These results provide promising evidence about the potential benefit of dexmedetomidine for AWS.
PURPOSE: Although benzodiazepines are first-line drugs for alcohol withdrawal syndrome (AWS), rapidly escalating doses may offer little additional benefit and increase complications. The purpose of this study was to evaluate dexmedetomidine's impact on benzodiazepine requirements and hemodynamics in AWS. MATERIALS AND METHODS: This retrospective case series evaluated 33 critically ill adults with a primary diagnosis of AWS from 2006 to 2012 at an academic medical center. RESULTS:Dexmedetomidine began a median (interquartile range) of 11 (2, 32) hours into intensive care unit admission and was titrated to an infusion rate of 0.7 (0.4, 0.7) μg kg(-1) h(-1) to achieve the desired depth of sedation. In the 12 hours after dexmedetomidine began, patients experienced a 20-mg reduction in median cumulative benzodiazepine dose used (P < .001), a 14-mm Hg lower mean arterial pressure (P = .03), and a 17-beats/min reduction in median heart rate (P < .001). Four (12%) patients experienced hypotension (systolic blood pressure <80 mm Hg) during therapy, and there were no cases of bradycardia (heart rate <40 beats/min). CONCLUSION:Dexmedetomidine decreased benzodiazepine requirements and improved the overall hemodynamic profile of patients with severe AWS. These results provide promising evidence about the potential benefit of dexmedetomidine for AWS.
Authors: Joshua T Smith; Mary Sage; Herb Szeto; Laura C Myers; Yun Lu; Adriana Martinez; Patricia Kipnis; Vincent X Liu Journal: JAMA Netw Open Date: 2022-02-01
Authors: Tessa L Steel; Majid Afshar; Scott Edwards; Sarah E Jolley; Christine Timko; Brendan J Clark; Ivor S Douglas; Amy L Dzierba; Hayley B Gershengorn; Nicholas W Gilpin; Dwayne W Godwin; Catherine L Hough; José R Maldonado; Anuj B Mehta; Lewis S Nelson; Mayur B Patel; Darius A Rastegar; Joanna L Stollings; Boris Tabakoff; Judith A Tate; Adrian Wong; Ellen L Burnham Journal: Am J Respir Crit Care Med Date: 2021-10-01 Impact factor: 21.405