title: Alcohol, nicotine, and iatrogenic withdrawals in the ICU.
abstract: OBJECTIVE
  The neurophysiology, risk factors, and screening tools associated with alcohol withdrawal syndrome in the ICU are reviewed. Alcohol withdrawal syndrome assessment and its treatment options are discussed. Description of nicotine withdrawal and related publications specific to the critically ill are also reviewed. A brief comment as to sedative and opiate withdrawal follows.
  The role of currently published alcohol withdrawal syndrome pharmacologic strategies (benzodiazepines, ethanol, clomethiazole, antipsychotics, barbiturates, propofol, and dexmedetomidine) is detailed. Studies on nicotine withdrawal management in the ICU focus mainly on the safety (mortality) of nicotine replacement therapy. Study characteristics and methodological limitations are presented.
  
  
  CONCLUSIONS
  We recommend a pharmacologic regimen titrated to withdrawal symptoms in ICU patients with alcohol withdrawal syndrome. Benzodiazepines are a reasonable option; phenobarbital appears to confer some advantages in combination with benzodiazepines. Propofol and dexmedetomidine have not been rigorously tested in comparative studies of drug withdrawal treatment; their use as additional or alternative strategies for managing withdrawal syndromes in ICU patients should therefore be individualized to each patient. Insufficient data preclude recommendations as to nicotine replacement therapy and management of iatrogenic drug withdrawal in ICU patients.
authors.affiliation: Pharmacy Department, Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada.
authors.forename: Don-Kelena
authors.initials: DK
authors.lastname: Awissi
authors.forename: Genevieve
authors.initials: G
authors.lastname: Lebrun
authors.forename: Mylene
authors.initials: M
authors.lastname: Fagnan
authors.forename: Yoanna
authors.initials: Y
authors.lastname: Skrobik
mesh_terms: D000430:Alcohol Withdrawal Delirium / Q000175:diagnosis / Q000188:drug therapy; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D006801:Humans; D007049:Iatrogenic Disease; D007362:Intensive Care Units; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000188:drug therapy; D019966:Substance-Related Disorders / Q000188:drug therapy; D014029:Tobacco Use Disorder; D014481:United States