title: Alcohol withdrawal and delirium tremens in the critically ill: a systematic review and commentary.
abstract: BACKGROUND
  Alcohol withdrawal is common among intensive care unit (ICU) patients, but no current practice guidelines exist. We reviewed published manuscripts for prevalence, risk factors, screening tools, prophylactic and treatment strategies, and outcomes for alcohol withdrawal syndrome (AWS) and delirium tremens (DT) in the critically ill.
  
  
  METHODS
  The following databases: PubMed, MEDLINE, Embase, Cochrane Database of Systematic Reviews and Central Register of Controlled Trials, CINAHL, Scopus, Web of Knowledge, pain, anxiety and delirium (PAD) Guidelines REFWORKS, International Pharmaceutical Abstracts and references for published papers were searched. Publications with high or moderate Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Oxford levels of evidence were included.
  
  
  RESULTS
  Reported AWS rates range from <1 % in 'all ICU comers' to 60 % in highly selected alcohol-dependent ICU patients. Alcohol dependence and a history of withdrawal are significant risk factors for AWS occurrence. No screening tools for withdrawal have been validated in the ICU. The benefit of alcohol withdrawal prophylaxis is unproven, and proposed regimens appear equivalent. Early and aggressive titration of medication guided by symptoms is the only feature associated with improved treatment outcome.
  
  
  CONCLUSIONS
  Treatment of AWS is associated with higher ICU complication rates and resource utilization. The optimal means of identification, prevention and treatment of AWS in order to establish evidence-based guidelines remain to be determined.
authors.affiliation: Pharmacy Department, Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l'Assomption, Montreal, PQ, H1T 2M4, Canada.
authors.forename: Don-Kelena
authors.initials: DK
authors.lastname: Awissi
authors.forename: Genevieve
authors.initials: G
authors.lastname: Lebrun
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Coursin
authors.forename: Richard R
authors.initials: RR
authors.lastname: Riker
authors.forename: Yoanna
authors.initials: Y
authors.lastname: Skrobik
mesh_terms: D000430:Alcohol Withdrawal Delirium / Q000175:diagnosis / Q000628:therapy*; D016638:Critical Illness; D000431:Ethanol / Q000009:adverse effects*; D006801:Humans; D007362:Intensive Care Units; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000628:therapy*
chemical_list: D000431:Ethanol