title: Use of propofol-containing versus benzodiazepine regimens for alcohol withdrawal requiring mechanical ventilation.
abstract: BACKGROUND
  When chronic, excessive alcohol intake is abruptly halted, patients are at risk for developing life-threatening alcohol withdrawal syndrome (AWS). Benzodiazepines have established efficacy, yet some patients' symptoms persist despite treatment with high doses.
  
  
  OBJECTIVE
  The study objective was to compare time to resolution of AWS symptoms in mechanically ventilated patients receiving propofol-containing versus benzodiazepine infusions.
  
  
  METHODS
  This study was a retrospective cohort analysis of adult patients with ICD-9 codes for AWS who required mechanical ventilation for AWS symptoms.
  
  
  RESULTS
  A total of 1637 records were reviewed, and 64 were included. Propofol-containing regimens were used in 46 cases (72%), whereas benzodiazepine infusion monotherapy accounted for 18 cases (28%). Patients were predominantly male (97%), with a mean age of 45 years. Lorazepam-equivalent benzodiazepine doses given prior to intubation were greater in patients receiving propofol infusion (56 vs 15 mg, P = .03). Time to resolution of AWS symptoms for propofol- and benzodiazepine-treated patients was 8 and 7 days, respectively (P = .34). Median hospital and intensive care unit lengths of stay were similar (9 vs 10 days and 4 vs 4 days, respectively; P > .05 for both comparisons), as were days of mechanical ventilation (4 vs 3 days, P = .98). Patients in the benzodiazepine infusion monotherapy group required numerically increased amounts of benzodiazepine bolus doses while on continuous sedation, compared with patients receiving propofol infusion (36 vs 10 mg, P = .06).
  
  
  CONCLUSIONS
  Propofol and Benzodiazepine-treated patients with AWS requiring mechanical ventilation experienced similar days of AWS symptoms, length of stay, and mechanical ventilation.
authors.affiliation: University Health System, San Antonio, TX, USA.
authors.forename: Rose
authors.initials: R
authors.lastname: Sohraby
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Attridge
authors.forename: Darrel W
authors.initials: DW
authors.lastname: Hughes
mesh_terms: D000328:Adult; D001569:Benzodiazepines / Q000627:therapeutic use*; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007902:Length of Stay; D008140:Lorazepam / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000627:therapeutic use*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*
chemical_list: D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D000431:Ethanol; D008140:Lorazepam; D015742:Propofol
keywords: alcohol withdrawal syndrome; benzodiazepines; delirium tremens; intensive care unit; mechanically ventilated; propofol; resolution of symptoms