A randomized controlled study of additive use of dexmedetomidine to benzodiazepines for patients with alcohol withdrawal syndrome

Abstract

Dexmedetomidine has the ability of producing sedation and to inhibit the adrenergic system without respiratory depression, what makes it a promising agent in the management of alcohol withdrawal syndrome. So, the objective of this randomized controlled trial was to evaluate safety and efficacy of dexmedetomidine added to usual diazepam therapy compared to diazepam only. All eligible patients were randomly divided into two group: intervention (Group D; n=36) and control (Group C; n=36). In Group D dexmedetomidine infusion was started at a dose of 0.2–1.4 мg/kg/h and titrated up to achieving target sedation level (-2 to 0 on the Richmond Agitation Sedation Scale (RASS)) with symptom-triggered benzodiazepine (10mg bolus of diazepam) used as needed. Patients in control group received only diazepam boluses. Primary efficacy outcomes were: 24-hour diazepam consumption and cumulative diazepam dose through the period of ICU stay. Secondary outcomes were length of the ICU stay, sedation and communication quality and haloperidol requirements. Median 24-hour diazepam consumption was significantly lower in Group D, likewise the median cumulative diazepam dose. Patients in Group D had better median percentage of time in target sedation range (p<0.001). Also, DEX infusion was associated with better nurse-assessed patient communication (p<0.001) and fewer patients required haloperidol treatment. No severe adverse effects were registered in either group. All patients remained on spontaneous breathing. Bradycardia was more common adverse effect in Group D. Dexmedetomidine infusion was associated with higher amount of time in target sedation range, better nurse-patient communication and with reduced diazepam requirements and lower percent of patients who required haloperidol for severe agitation and hallucinations.