title: Influence of dexmedetomidine therapy on the management of severe alcohol withdrawal syndrome in critically ill patients.
abstract: OBJECTIVE
  Although benzodiazepines are first-line drugs for alcohol withdrawal syndrome (AWS), rapidly escalating doses may offer little additional benefit and increase complications. The purpose of this study was to evaluate dexmedetomidine's impact on benzodiazepine requirements and hemodynamics in AWS.
  
  
  METHODS
  This retrospective case series evaluated 33 critically ill adults with a primary diagnosis of AWS from 2006 to 2012 at an academic medical center.
  
  
  RESULTS
  Dexmedetomidine began a median (interquartile range) of 11 (2, 32) hours into intensive care unit admission and was titrated to an infusion rate of 0.7 (0.4, 0.7) μg kg(-1) h(-1) to achieve the desired depth of sedation. In the 12 hours after dexmedetomidine began, patients experienced a 20-mg reduction in median cumulative benzodiazepine dose used (P < .001), a 14-mm Hg lower mean arterial pressure (P = .03), and a 17-beats/min reduction in median heart rate (P < .001). Four (12%) patients experienced hypotension (systolic blood pressure <80 mm Hg) during therapy, and there were no cases of bradycardia (heart rate <40 beats/min).
  
  
  CONCLUSIONS
  Dexmedetomidine decreased benzodiazepine requirements and improved the overall hemodynamic profile of patients with severe AWS. These results provide promising evidence about the potential benefit of dexmedetomidine for AWS.
authors.affiliation: Hospital Pharmacy Services, Mayo Clinic, Rochester, MN. Electronic address: frazee.erin@mayo.edu.
authors.forename: Erin N
authors.initials: EN
authors.lastname: Frazee
authors.affiliation: Hospital Pharmacy Services, Mayo Clinic, Rochester, MN.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Personett
authors.affiliation: Hospital Pharmacy Services, Mayo Clinic, Rochester, MN.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Leung
authors.affiliation: Hospital Pharmacy Services, Mayo Clinic, Rochester, MN.
authors.forename: Sarah
authors.initials: S
authors.lastname: Nelson
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Ross A
authors.initials: RA
authors.lastname: Dierkhising
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Philippe R
authors.initials: PR
authors.lastname: Bauer
mesh_terms: D000328:Adult; D001569:Benzodiazepines / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D016638:Critical Illness; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000009:adverse effects; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007022:Hypotension / Q000139:chemically induced; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D000431:Ethanol; D020927:Dexmedetomidine
keywords: Alcohol withdrawal delirium; Alcoholic intoxication; Conscious sedation; Critical illness; Dexmedetomidine