[Ethanol for treatment of delirium in alcohol dependent patients on intensive care units in the Netherlands: efficacy not proven].
OBJECTIVE
To determine the use of ethanol in Dutch intensive care departments (ICUs) for the treatment of deliriant symptoms in alcohol-dependent patients, and to study the literature data concerning this use.


METHODS
Literature search and questionnaire.


METHODS
In Medline a search was performed from 1993 onward with keywords 'intensive care' and 'alcohol'/'alcohol withdrawal syndrome'/'delirium'. All Dutch ICUs received a written questionnaire (n = 247) concerning the use of ethanol in this patient group.


RESULTS
According to the literature the syndrome is characterized by autonomous hyperactivity, resulting in tachycardia, tachypnoea, hypertension, perspiration, fever, tremors en fear. In delirium caused by alcohol withdrawal benzodiazepines are advised, sometimes in combination with haloperidol. ICUs sometimes use ethanol, although the effectiveness in preventing or treating withdrawal symptoms has never been ascertained in scientific investigations: in a meta-analysis the conclusion is drawn that the studies are too small and insufficiently objective to determine the effectiveness. The response to the questionnaire was 55% (96/176). From all ICUs, 15 (16%) used ethanol occasionally, and treated an estimated 17% of the admitted alcohol-dependent patients. There was a tendency for large ICUs to use ethanol in these patients more frequently. Each ICU used its own method to calculate the required ethanol dosage. Calculation on the basis of these dosages indicated a plasma ethanol concentration of at most 0.5 promille.


CONCLUSIONS
Because only a small percentage of deliriums on ICUs are caused by alcohol withdrawal, and the effectiveness of ethanol in alcohol-dependent patients with a delirium has never been proven, the use of ethanol in such cases is discouraged.
van Klei
W A
WA
Universitair Medisch Centrum, Utrecht. w.a.vanklei@anest.azu.nl
Havenaar
J M
JM
Klijn
F A
FA
van Dijk
A
A
D000430:Alcohol Withdrawal Delirium / Q000188:drug therapy*; D002492:Central Nervous System Depressants / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D003422:Critical Care / Q000379:methods*; D004363:Drug Utilization; D000431:Ethanol / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D009426:Netherlands; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
D002492:Central Nervous System Depressants; D000431:Ethanol