Department of Pharmacy, UNC REX, Raleigh, NC, USA.
Department of Pharmacy, Baylor Scott & White Medical Center-Round Rock, TX, USA.
J Pharm Pract. 2022 Jun;35(3):356-362. doi: 10.1177/0897190020977755. Epub 2020 Dec 10.
This study evaluated the safety and efficacy of adjunctive dexmedetomidine for alcohol withdrawal syndrome (AWS) treatment compared to symptom-triggered benzodiazepine therapy.
This single-center, retrospective, cohort study evaluated patients admitted to an intensive care unit (ICU) with AWS. Patients were divided into 2 groups: adjunctive dexmedetomidine or symptom-triggered therapy (control). Primary outcome was change in Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) score. Secondary outcomes assessed cumulative ICU benzodiazepine requirement and ICU/hospital length of stay (LOS). Safety outcomes evaluated incidence of adverse events, new onset seizures, and intubation. Propensity matching was performed to minimize differences between study groups.
Overall, 147 patients were included, 56 in the dexmedetomidine group and 91 in the control group. Patient demographics were similar, however baseline CIWA-Ar score was statistically higher in the dexmedetomidine group. Following propensity matching, 55 patients were included in each group. No significant difference was noted for change in CIWA-Ar score (median, IQR) [3.8 (-0.4-12.3) dexmedetomidine vs. 5.4 (1.4-12.9) control, p = 0.223]. Secondary endpoints revealed increased benzodiazepine requirements (p = 0.001), prolonged ICU LOS (p = 0.050), and more frequent use of physical restraints (p = 0.001) in the dexmedetomidine group. While not statistically significant, the development of new onset seizures (p = 0.775) and intubation (p = 0.294) occurred more frequently in the dexmedetomidine group.
The addition of dexmedetomidine to symptom-triggered benzodiazepines for AWS did not produce a significant change in CIWA-Ar scores from baseline compared to symptom-triggered therapy alone. The increased rate of new onset seizures and intubation warrant further investigation into the safety of dexmedetomidine in AWS.
本研究评估了辅助用右美托咪定治疗酒精戒断综合征（AWS）与症状触发的苯二氮䓬类药物治疗相比的安全性和疗效。
这是一项单中心、回顾性队列研究，评估了入住重症监护病房（ICU）的 AWS 患者。患者分为两组：辅助用右美托咪定或症状触发治疗（对照组）。主要结局是临床戒断评估酒精量表（CIWA-Ar）评分的变化。次要结局评估 ICU 苯二氮䓬类药物的累积需求和 ICU/医院住院时间（LOS）。安全性结局评估不良事件、新发性癫痫发作和插管的发生率。采用倾向匹配来最小化研究组之间的差异。
总体而言，共纳入 147 例患者，其中右美托咪定组 56 例，对照组 91 例。患者的人口统计学特征相似，但右美托咪定组的基线 CIWA-Ar 评分更高。经过倾向匹配后，每组纳入 55 例患者。CIWA-Ar 评分的变化（中位数，IQR）[3.8（-0.4-12.3）右美托咪定与 5.4（1.4-12.9）对照组，p = 0.223]无显著差异。次要终点显示右美托咪定组需要更多的苯二氮䓬类药物（p = 0.001）、ICU LOS 延长（p = 0.050）和更频繁地使用身体约束（p = 0.001）。虽然无统计学意义，但右美托咪定组新发癫痫发作（p = 0.775）和插管（p = 0.294）的发生率更高。
与单独症状触发治疗相比，AWS 中辅助用右美托咪定联合症状触发的苯二氮䓬类药物治疗并未使 CIWA-Ar 评分从基线显著改变。新发性癫痫发作和插管的发生率增加，需要进一步研究右美托咪定在 AWS 中的安全性。
