title: Multicenter evaluation of pharmacologic management and outcomes associated with severe resistant alcohol withdrawal.
abstract: BACKGROUND
  A subset of patients with alcohol withdrawal syndrome does not respond to benzodiazepine treatment despite escalating doses. Resistant alcohol withdrawal (RAW) is associated with higher incidences of mechanical ventilation and nosocomial pneumonia and longer intensive care unit (ICU) stay. The objective of this study is to characterize pharmacologic management of RAW and outcomes.
  
  
  METHODS
  Adult patients were identified retrospectively via International Classification of Diseases, Ninth Revision codes for severe alcohol withdrawal from 2009 to 2012 at 3 hospitals. Data collected included pharmacologic management and clinical outcomes.
  
  
  RESULTS
  A total of 184 patients met inclusion criteria. Sixteen medications and 74 combinations of medications were used for management. Propofol was the most common adjunct agent, with dexmedetomidine and antipsychotics also used. One hundred seventy-five patients (96.2%) were admitted to the ICU, with 149 patients (81.9%) requiring ventilator support. Median time to resolution of alcohol withdrawal syndrome from RAW designation was 6.0 days. Median ICU and hospital length of stay were 9.0 and 12.7 days, respectively.
  
  
  CONCLUSIONS
  Diverse patterns exist in the management of patients meeting RAW criteria, indicating lack of refined approach to treatment. High doses of sedatives used for these patients may result in a high level of care, illustrating a need for evidence-based clinical guidelines to optimize outcomes.
authors.affiliation: Department of Pharmacy, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, PA, USA.
authors.forename: Adrian
authors.initials: A
authors.lastname: Wong
authors.affiliation: Department of Pharmacy, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, PA, USA; Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA. Electronic address: benedictnj@upmc.edu.
authors.forename: Neal J
authors.initials: NJ
authors.lastname: Benedict
authors.affiliation: Department of Pharmacy, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, PA, USA; Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Kane-Gill
mesh_terms: D000328:Adult; D000430:Alcohol Withdrawal Delirium / Q000188:drug therapy* / Q000453:epidemiology; D020270:Alcohol Withdrawal Seizures / Q000188:drug therapy* / Q000453:epidemiology; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D003428:Cross Infection / Q000453:epidemiology; D020927:Dexmedetomidine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology; D015742:Propofol / Q000627:therapeutic use*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D020927:Dexmedetomidine; D015742:Propofol
keywords: Alcohol withdrawal delirium; Alcohol withdrawal seizures; Benzodiazepines; Resistant alcohol withdrawal; Severe alcohol withdrawal