title: Dexmedetomidine in addition to benzodiazepine-based sedation in patients with alcohol withdrawal delirium.
abstract: Alcohol withdrawal delirium (AWD) is often refractory to conventional medication. We report a prospective series of patients treated with α2-agonist dexmedetomidine added to conventional sedation. Eighteen patients with AWD were diagnosed by Confusion assessment method for ICU score. Treatment, complications, length of stay (LOS) in ICU and hospital were recorded. In addition, hospital and 1-year mortality were assessed. Dexmedetomidine was given for 23.9 (18.4) h [mean (SD)]. All the patients also received benzodiazepines but three patients were given haloperidole. No patient was intubated. The maximum infusion rate of dexmedetomidine was 1.5 (1.2) µg/kg/h. Time to resolution of AWD was 3.8 (1.3) days. The ICU LOS was 7.1 (2.7) days and in-hospital LOS 12.1 (4.5) days. No adverse events were observed although one patient died from acute pancreatitis. The use of dexmedetomidine in AWD seems safe but warrants further studies.
authors.affiliation: aDepartment of Medicine, Division of Emergency Medicine, Helsinki and Uusimaa District University Hospital, Helsinki bDepartment of Emergency Medicine, Middle Finland Central Hospital, Jyväskylä cNational Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Tolonen
authors.forename: Juhani
authors.initials: J
authors.lastname: Rossinen
authors.forename: Hannu
authors.initials: H
authors.lastname: Alho
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
mesh_terms: D000328:Adult; D000368:Aged; D000430:Alcohol Withdrawal Delirium / Q000175:diagnosis / Q000188:drug therapy*; D001569:Benzodiazepines / Q000008:administration & dosage*; D015331:Cohort Studies; D016292:Procedural Sedation / Q000379:methods; D003422:Critical Care / Q000379:methods; D020927:Dexmedetomidine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D020927:Dexmedetomidine