VanderWeide Luke A, Foster Charles J, MacLaren Robert, Kiser Tyree H, Fish Douglas N, Mueller Scott W
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USA.
J Intensive Care Med. 2016 Mar;31(3):198-204. doi: 10.1177/0885066614554908. Epub 2014 Oct 16.
This study evaluated the impact of dexmedetomidine (DEX) administration on benzodiazepine (BZD) requirements in intensive care unit (ICU) patients experiencing alcohol withdrawal syndrome (AWS).
This trial included adults admitted to the ICU for >24 hours for AWS. Early DEX was defined as receiving DEX within 60 hours of hospital admission. The primary outcome was 12-hour BZD requirement from the inflection point or DEX initiation. Secondary outcomes included 24-hour BZD requirements, symptom control, ICU and hospital length of stay, and incidence and duration of mechanical ventilation. Safety outcomes included incidence of bradycardia and hypotension.
Twenty patients receiving DEX were matched to 22 control patients. The mean 12-hour change in BZD requirement was significantly different for DEX versus control (-20 vs -8.3 mg, P = .0455) with a trend toward significance at 24 hours (-29.6 vs -11 mg, P = .06). No significant differences were noted in other secondary outcomes. Patients receiving DEX experienced significantly more bradycardia than controls (35% vs 0%, P < .01) but not hypotension.
This study suggests DEX is associated with a reduction in BZD requirement when utilized as adjunctive therapy for AWS. A larger prospective trial is needed to evaluate the clinical impact of DEX for AWS.
本研究评估了右美托咪定（DEX）给药对患有酒精戒断综合征（AWS）的重症监护病房（ICU）患者苯二氮䓬类药物（BZD）需求的影响。
本试验纳入因AWS入住ICU超过24小时的成年人。早期DEX定义为在入院60小时内接受DEX治疗。主要结局是从拐点或开始使用DEX起12小时内的BZD需求量。次要结局包括24小时BZD需求量、症状控制情况、ICU和住院时间以及机械通气的发生率和持续时间。安全性结局包括心动过缓和低血压的发生率。
20例接受DEX治疗的患者与22例对照患者进行匹配。DEX组与对照组相比，BZD需求量的平均12小时变化有显著差异（-20 vs -8.3 mg，P = 0.0455），24小时时有显著差异的趋势（-29.6 vs -11 mg，P = 0.06）。在其他次要结局方面未观察到显著差异。接受DEX治疗的患者心动过缓的发生率显著高于对照组（35% vs 0%，P < 0.01），但低血压发生率无差异。
本研究表明，DEX作为AWS的辅助治疗药物与BZD需求量的减少有关。需要进行更大规模的前瞻性试验来评估DEX对AWS的临床影响。
