Management of alcohol withdrawal delirium. An evidence-based practice guideline.
BACKGROUND
Alcohol withdrawal delirium is the most serious manifestation of alcohol withdrawal. Evidence suggests that appropriate care improves mortality, but systematic reviews are unavailable.


METHODS
Articles with original data on management of alcohol withdrawal delirium underwent structured review and meta-analysis.


RESULTS
Meta-analysis of 9 prospective controlled trials demonstrated that sedative-hypnotic agents are more effective than neuroleptic agents in reducing duration of delirium and mortality, with a relative risk of death when using neuroleptic agents of 6.6. Statistically significant differences among various benzodiazepines and barbiturates were not found. No deaths were reported in 217 patients from trials using benzodiazepines or barbiturates.


CONCLUSIONS
Control of agitation should be achieved using parenteral rapid-acting sedative-hypnotic agents that are cross-tolerant with alcohol. Adequate doses should be used to maintain light somnolence for the duration of delirium. Coupled with comprehensive supportive medical care, this approach is highly effective in preventing morbidity and mortality.
Mayo-Smith
Michael F
MF
Primary Care Service, Veterans Administration Medical Center, Manchester, NH 03104, USA. Michael.Mayo-Smith@med.va.gov
Beecher
Lee H
LH
Fischer
Timothy L
TL
Gorelick
David A
DA
Guillaume
Jeanette L
JL
Hill
Arnold
A
Jara
Gail
G
Kasser
Chris
C
Melbourne
John
J
D000430:Alcohol Withdrawal Delirium / Q000188:drug therapy* / Q000191:economics; D014150:Antipsychotic Agents / Q000191:economics / Q000592:standards / Q000627:therapeutic use; D001569:Benzodiazepines / Q000191:economics / Q000592:standards / Q000627:therapeutic use; D018849:Controlled Clinical Trials as Topic; D003365:Costs and Cost Analysis; D019468:Disease Management; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D015201:Meta-Analysis as Topic; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000191:economics
D014150:Antipsychotic Agents; D001569:Benzodiazepines