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Dexmedetomidine Utilization for Alcohol Withdrawal in a Community Hospital ICU
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A1878 - Dexmedetomidine Utilization for Alcohol Withdrawal in a Community Hospital ICU
Author Block: I. Butler1, J. Curtis2, R. Haskell2; 1Critical Care, Palomar Medical Center, San Diego, CA, United States, 2Critical Care, Chester County Hospital, West Chester, PA, United States.
Introduction: The role of dexmedetomidine (DEX) in acute alcohol withdrawal remains unclear but may decrease rates of intubation and benzodiazepine requirements. Our ICU practice has been to use DEX as a first-line agent and then add lorazepam 1-2 mg as needed. In this case-series we present our experience over the last 2 years of using DEX for the treatment of alcohol withdrawal.
Methods: A convenience sample comprised of patients admitted to the ICU for primary treatment of alcohol withdrawal over 2 consecutive years ending in June of 2016. Chart review then determined patient origin and demographics as well as what medications patients were treated. Patients were further evaluated for seizures, intubation, restraint and sitter utilization. ICU and hospital length of stay were also calculated.
Results: The intensivist service admitted 19 patients to the ICU for primary treatment of alcohol withdrawal with 5 of the patients having seizures on admission. The patients were 84% male and had an average age of 45.8 with 42% transferred from the floor and the remainder being admitted through the emergency room. None of the patients over this two-year period required intubation. 26% of the patients required restraints and 47% required a sitter for an average of 16 hours. Mean ICU LOS was 1.42 days (SD=0.61 days), and overall hospital LOS was 5.15 days (SD=3.37). The number of PRN lorazepam doses given during treatment in the ICU averaged 7.7 doses per patient.
Conclusion: While the role of DEX in acute alcohol withdrawal remains unclear, the fact that none of our patients required intubation lends support to the hypothesis that DEX utilization in this population decreases rates of intubation. Further, our LOS is consistent with previously reported LOS for patients treated with DEX for alcohol withdrawal reported by Smith et al (ICU LOS = 2.2 days, hospital LOS = 5.7 days).
Author Block: I. Butler1, J. Curtis2, R. Haskell2; 1Critical Care, Palomar Medical Center, San Diego, CA, United States, 2Critical Care, Chester County Hospital, West Chester, PA, United States.
Introduction: The role of dexmedetomidine (DEX) in acute alcohol withdrawal remains unclear but may decrease rates of intubation and benzodiazepine requirements. Our ICU practice has been to use DEX as a first-line agent and then add lorazepam 1-2 mg as needed. In this case-series we present our experience over the last 2 years of using DEX for the treatment of alcohol withdrawal.
Methods: A convenience sample comprised of patients admitted to the ICU for primary treatment of alcohol withdrawal over 2 consecutive years ending in June of 2016. Chart review then determined patient origin and demographics as well as what medications patients were treated. Patients were further evaluated for seizures, intubation, restraint and sitter utilization. ICU and hospital length of stay were also calculated.
Results: The intensivist service admitted 19 patients to the ICU for primary treatment of alcohol withdrawal with 5 of the patients having seizures on admission. The patients were 84% male and had an average age of 45.8 with 42% transferred from the floor and the remainder being admitted through the emergency room. None of the patients over this two-year period required intubation. 26% of the patients required restraints and 47% required a sitter for an average of 16 hours. Mean ICU LOS was 1.42 days (SD=0.61 days), and overall hospital LOS was 5.15 days (SD=3.37). The number of PRN lorazepam doses given during treatment in the ICU averaged 7.7 doses per patient.
Conclusion: While the role of DEX in acute alcohol withdrawal remains unclear, the fact that none of our patients required intubation lends support to the hypothesis that DEX utilization in this population decreases rates of intubation. Further, our LOS is consistent with previously reported LOS for patients treated with DEX for alcohol withdrawal reported by Smith et al (ICU LOS = 2.2 days, hospital LOS = 5.7 days).
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