Abstract
PurposeAlcohol withdrawal syndrome (AWS) is commonly treated in medical ICUs and typically requires high resource utilization. Dexmedetomidine for AWS has not been extensively investigated, and guidelines regarding its use are lacking. We evaluated the association between dexmedetomidine use in AWS and ICU length of stay (LOS).MethodsWe performed a multi-institutional retrospective cohort study of patients in the ICU with the primary diagnosis of AWS. ICU LOS of those treated with benzodiazepines alone vs. benzodiazepines plus dexmedetomidine was compared. Negative binomial regression was performed to test whether dexmedetomidine use was associated with increased ICU LOS after adjustment for age, gender, body mass index, and the time between hospital and ICU admission.ResultsFour hundred thirty-eight patients from eight institutions were included. Patients treated with benzodiazepines plus dexmedetomidine had higher Clinical Institute Withdrawal Assessment for Alcohol scores at ICU admission, spent longer on the medical wards prior to ICU admission, and had longer unadjusted ICU LOS (p < 0.0001). After covariate adjustment, dexmedetomidine remained associated with longer ICU LOS (relative mean to non-dexmedetomidine group 2.14, 95% CI 1.78–2.57, p < 0.0001).ConclusionsCompared to benzodiazepines alone, dexmedetomidine for the treatment of AWS was associated with increased ICU LOS. These results provide evidence that dexmedetomidine may increase resource utilization.
Highlights
Alcohol withdrawal syndrome (AWS) accounts for 9% of intensive care unit (ICU) admissions in the USA and 13% of overall ICU costs [1]
We hypothesized that dexmedetomidine use would be associated with longer ICU lengths of stay compared to benzodiazepines alone because of its need to be administered in an ICU setting
Exclusion criteria included any patient with an alternative primary indication for ICU admission other than alcohol withdrawal, intubation prior to or during an ICU admission, admission Clinical Institute Withdrawal Assessment for Alcohol (CIWA) score of 0 or CIWA not recorded, patients who died during their ICU stay, patients transferred directly to the ICU from an outside hospital, patients who left the hospital against medical advice, and patients transferred to an alternative ICU
Summary
We conducted a multi-institutional retrospective cohort study of patients admitted to the ICU with the primary diagnosis of AWS within the Steward Health Care System in Massachusetts following the STROBE guidelines [9]. Study cohort For this study, eligible patients were defined as those admitted to the ICU at eight hospitals within the Steward Health Care System with a primary diagnosis of alcohol withdrawal. Exposure was defined as the administration of adjunctive dexmedetomidine within 1 h of arrival to the ICU for management of AWS All subjects in this group received benzodiazepines either prior to, during, or following dexmedetomidine infusion. We compared ICU LOS between groups using negative binomial regression with generalized estimating equations to account for clustering of patients within hospitals. SAS version 9.3 was used for the statistical analysis (SAS Institute, Cary, NC)
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