Alcohol Withdrawal Syndrome in the ICU: Preventing Rather than Treating?

Abstract

Chronic alcohol consumption may lead to alcohol use disorders. Alcohol use disorders are considered by the World Health Organization as a public health issue worldwide. Alcohol use disorders are an independent cause of frailty and may increase patient morbidity and mortality. An unplanned and brutal halt to alcohol consumption, as can occur during intensive care unit (ICU) admission, may lead to an alcohol withdrawal syndrome. Although the health consequences of alcohol use disorders are well acknowledged, the consequences of alcohol withdrawal syndrome are less known by clinicians. Alcohol withdrawal syndrome may lead to acute complications and also has long-term effects by increasing neuron damage. Up to 20% of ICU patients have alcohol use disorder in their medical history. These patients are at high risk of presenting an alcohol withdrawal syndrome. Alcohol withdrawal syndrome is considered to be an independent factor for worsening a patient’s initial illness as it increases the risk of sepsis, mechanical ventilation, ICU length of stay, and mortality. Despite being very common and severe, only a few studies have focused on treatment of alcohol withdrawal syndrome in the ICU. Benzodiazepines remain the first line of treatment, and adjunct therapy such as neuroleptic or propofol has not proved useful. Considering the impact of alcohol withdrawal syndrome on patient outcome, it seems more relevant to apply a prophylactic than a wait and see approach. Although there is need for scientific evidence to translate the prophylactic approach into daily clinical practice, it may be more relevant and lead to a significant improvement in outcome of ICU patients with alcohol use disorders.