title: Evaluation of Early Dexmedetomidine Addition to the Standard of Care for Severe Alcohol Withdrawal in the ICU: A Retrospective Controlled Cohort Study.
abstract: OBJECTIVE
  This study evaluated the impact of dexmedetomidine (DEX) administration on benzodiazepine (BZD) requirements in intensive care unit (ICU) patients experiencing alcohol withdrawal syndrome (AWS).
  
  
  METHODS
  This trial included adults admitted to the ICU for >24 hours for AWS. Early DEX was defined as receiving DEX within 60 hours of hospital admission. The primary outcome was 12-hour BZD requirement from the inflection point or DEX initiation. Secondary outcomes included 24-hour BZD requirements, symptom control, ICU and hospital length of stay, and incidence and duration of mechanical ventilation. Safety outcomes included incidence of bradycardia and hypotension.
  
  
  RESULTS
  Twenty patients receiving DEX were matched to 22 control patients. The mean 12-hour change in BZD requirement was significantly different for DEX versus control (-20 vs -8.3 mg, P = .0455) with a trend toward significance at 24 hours (-29.6 vs -11 mg, P = .06). No significant differences were noted in other secondary outcomes. Patients receiving DEX experienced significantly more bradycardia than controls (35% vs 0%, P < .01) but not hypotension.
  
  
  CONCLUSIONS
  This study suggests DEX is associated with a reduction in BZD requirement when utilized as adjunctive therapy for AWS. A larger prospective trial is needed to evaluate the clinical impact of DEX for AWS.
authors.affiliation: University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
authors.forename: Luke A
authors.initials: LA
authors.lastname: VanderWeide
authors.affiliation: Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Foster
authors.affiliation: Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: MacLaren
authors.affiliation: Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
authors.forename: Tyree H
authors.initials: TH
authors.lastname: Kiser
authors.affiliation: Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
authors.forename: Douglas N
authors.initials: DN
authors.lastname: Fish
authors.affiliation: Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA scott.mueller@ucdenver.edu.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Mueller
mesh_terms: D000328:Adult; D000368:Aged; D001569:Benzodiazepines / Q000008:administration & dosage*; D001919:Bradycardia / Q000139:chemically induced; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D003120:Colorado / Q000453:epidemiology; D003422:Critical Care / Q000379:methods*; D020927:Dexmedetomidine / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012189:Retrospective Studies; D059039:Standard of Care; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D001569:Benzodiazepines; D000431:Ethanol; D020927:Dexmedetomidine
keywords: alcohol withdrawal; benzodiazepines; critical illness; dexmedetomidine