874

Abstract

Introduction: Alcohol withdrawal is associated with increased morbidity and mortality, potential for intubation and mechanical ventilation requiring admission to the intensive care unit (ICU) and prolonged hospital length of stay (LOS). Benzodiazepines are the mainstay of therapy; however several case reports have demonstrated dexmedetomidine can be used as an adjunctive agent for treatment of alcohol withdrawal. Methods: A retrospective review was performed evaluating subjects that received continuous infusion benzodiazepines in addition to dexmedetomidine. The total benzodiazepine dose 24 hours before dexmedetomidine initiation and 2, 12 and 24 hours following was assessed. Additionally, ICU LOS, duration of mechanical ventilation, Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) scale, and heart rate and blood pressure were collected. Results: Thirty-seven subjects, 92% male, received dexmedetomidine and continuous infusion benzodiazepines. The mean CIWA-Ar score prior to dexmedetomidine was 10.54 and 24 hours post dexmedetomidine initiation and reduced to 7.4 ± 5. Mean heart rate 24 hours after dexmedetomidine was 80 bpm and mean systolic blood pressure (SBP) was 130 mmHg. The average ICU LOS was 10.7 days and 62.2% of subjects were mechanically ventilated for 7.18 ± 4.3 days. There was a statistically significant increase in ICU LOS in those that were mechanically ventilated and received dexmedetomidine (p= 0.017). Although there was a reduction in the benzodiazepine requirement at 2, 12 and 24 hours (3, 2.45, 1.9 mg/hr, respectively) the difference was not statistically significant (p= 0.23). There was a reduction in mean CIWA-Ar scores at 2, 12 and 24 hours (9.71, 8.41, 8.53, respectively); however the reduction was not statistically significant (p= 0.7). Conclusions: Perhaps due to a small sample size, these data do not demonstrate the anticipated decrease in duration of mechanical ventilation or reduction in ICU LOS in subjects that received dexmedetomidine in addition to benzodiazepines.