University of Minnesota Medical School, 1803 E John Street Seattle, Seattle, WA 98112, USA.
Ann Intensive Care. 2012 May 23;2(1):12. doi: 10.1186/2110-5820-2-12.
Patients undergoing alcohol withdrawal in the intensive care unit (ICU) often require escalating doses of benzodiazepines and not uncommonly require intubation and mechanical ventilation for airway protection. This may lead to complications and prolonged ICU stays. Experimental studies and single case reports suggest the α2-agonist dexmedetomidine is effective in managing the autonomic symptoms seen with alcohol withdrawal. We report a retrospective analysis of 20 ICU patients treated with dexmedetomidine for benzodiazepine-refractory alcohol withdrawal.
Records from a 23-bed mixed medical-surgical ICU were abstracted from November 2008 to November 2010 for patients who received dexmedetomidine for alcohol withdrawal. The main analysis compared alcohol withdrawal severity scores and medication doses for 24 h before dexmedetomidine therapy with values during the first 24 h of dexmedetomidine therapy.
There was a 61.5% reduction in benzodiazepine dosing after initiation of dexmedetomidine (n = 17; p < 0.001) and a 21.1% reduction in alcohol withdrawal severity score (n = 11; p = .015). Patients experienced less tachycardia and systolic hypertension following dexmedetomidine initiation. One patient out of 20 required intubation. A serious adverse effect occurred in one patient, in whom dexmedetomidine was discontinued for two 9-second asystolic pauses noted on telemetry.
This observational study suggests that dexmedetomidine therapy for severe alcohol withdrawal is associated with substantially reduced benzodiazepine dosing, a decrease in alcohol withdrawal scoring and blunted hyperadrenergic cardiovascular response to ethanol abstinence. In this series, there was a low rate of mechanical ventilation associated with the above strategy. One of 20 patients suffered two 9-second asystolic pauses, which did not recur after dexmedetomidine discontinuation. Prospective trials are warranted to compare adjunct treatment with dexmedetomidine versus standard benzodiazepine therapy.
在重症监护病房（ICU）中接受酒精戒断的患者通常需要逐渐增加苯二氮䓬类药物的剂量，并且为了保护气道，他们通常需要插管和机械通气。这可能导致并发症和 ICU 住院时间延长。实验研究和个案报告表明，α2-激动剂右美托咪定在治疗酒精戒断引起的自主神经症状方面是有效的。我们报告了对 20 例 ICU 患者使用右美托咪定治疗苯二氮䓬类药物难治性酒精戒断的回顾性分析。
从 2008 年 11 月至 2010 年 11 月，从 23 张混合内科-外科 ICU 病床的记录中提取了接受右美托咪定治疗酒精戒断的患者记录。主要分析比较了右美托咪定治疗前 24 小时和治疗后 24 小时的酒精戒断严重程度评分和药物剂量。
在开始使用右美托咪定后，苯二氮䓬类药物的剂量减少了 61.5%（n=17；p<0.001），酒精戒断严重程度评分降低了 21.1%（n=11；p=0.015）。患者在开始使用右美托咪定后心率加快和收缩压升高的情况减少。20 例患者中有 1 例需要插管。有 1 例患者出现严重不良反应，右美托咪定因 2 次遥测仪记录到 9 秒的停搏而被停用。
这项观察性研究表明，右美托咪定治疗严重酒精戒断与苯二氮䓬类药物剂量显著减少、酒精戒断评分降低以及乙醇戒断时去甲肾上腺素能心血管反应减弱有关。在本系列中，上述策略相关的机械通气率较低。20 例患者中有 1 例出现 2 次 9 秒的停搏，但在停用右美托咪定后不再复发。有必要进行前瞻性试验比较右美托咪定辅助治疗与标准苯二氮䓬类药物治疗。
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