Richman Lisa S, Garcia Carolyn, Bouchard Nicole, Muskin Philip R, Dzierba Amy L
J Psychiatr Pract. 2019 Jan;25(1):63-70. doi: 10.1097/PRA.0000000000000354.
Alcohol withdrawal is common in hospitalized patients and symptom-triggered guidelines have been shown to reduce treatment duration, length of stay, and need for mechanical ventilation.
To assess the feasibility of incorporating symptom-triggered alcohol withdrawal guidelines early in the hospital course and to evaluate outcomes of patients before and after implementation of the guidelines.
This was a retrospective pre-post study of adult patients admitted from the emergency department to an urban, academic, tertiary care center. Subjects in the preguideline (PRE) group were given benzodiazepines in a nonprotocolized manner at the discretion of the treating physician, whereas subjects in the postguideline (POST) group were treated according to the alcohol withdrawal guidelines with treatment beginning in the emergency department.
The PRE group involved 113 admissions for severe alcohol withdrawal and the POST group involved 103 admissions for severe alcohol withdrawal. The median benzodiazepine dose per day, in milligrams of chlordiazepoxide, was higher in the POST group (100 mg in the PRE group vs. 141 mg in the POST group; P<0.02). A higher percentage of patients in the POST group were admitted to the intensive care unit (4.4% in the PRE group vs. 12.6% in the POST group; P=0.05); however, more patients in the PRE group than in the POST group received continuous intravenous sedation and mechanical ventilation, although the difference was not statistically significant (P=0.37 for both variables). There was no difference between the 2 groups in length of stay in the intensive care unit or hospital or discharge disposition.
Incorporating symptom-triggered guidelines for alcohol withdrawal early in the hospital course at a large medical center is feasible. This approach may result in increased benzodiazepine use, but it seems that it is safe and does not result in adverse outcomes.
酒精戒断在住院患者中很常见，症状触发指南已被证明可缩短治疗时间、住院时长并减少机械通气需求。
评估在住院过程早期纳入症状触发酒精戒断指南的可行性，并评估指南实施前后患者的结局。
这是一项对从急诊科收治至一家城市学术三级护理中心的成年患者进行的回顾性前后对照研究。指南前（PRE）组的受试者由主治医生酌情以非标准化方式给予苯二氮䓬类药物，而指南后（POST）组的受试者则根据酒精戒断指南进行治疗，治疗从急诊科开始。
PRE组有113例因严重酒精戒断入院，POST组有103例因严重酒精戒断入院。以氯氮卓毫克数计，POST组每天苯二氮䓬类药物的中位剂量更高（PRE组为100mg，POST组为141mg；P<0.02）。POST组更高比例的患者被收入重症监护病房（PRE组为4.4%，POST组为12.6%；P=0.05）；然而，PRE组接受持续静脉镇静和机械通气的患者比POST组多，尽管差异无统计学意义（两个变量的P均为0.37）。两组在重症监护病房或医院的住院时长或出院处置方面无差异。
在大型医疗中心住院过程早期纳入症状触发酒精戒断指南是可行的。这种方法可能会导致苯二氮䓬类药物使用增加，但似乎是安全的，且不会导致不良结局。
