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接受氯氮䓬治疗酒精戒断症状的患者中需要机械通气的呼吸衰竭

Respiratory Failure Requiring Mechanical Ventilation Among Patients Receiving Chlordiazepoxide for Alcohol Withdrawal Symptoms.

作者信息

Reiter Nanna, Otte Helena Roed, Dalhoff Kim, Wamberg Christian Aage, Petersen Tonny Studsgaard, Meyhoff Christian S

机构信息

Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.

Department of Clinical Pharmacology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.

出版信息

Acta Anaesthesiol Scand. 2025 Jul;69(6):e70046. doi: 10.1111/aas.70046.


DOI:10.1111/aas.70046
PMID:40387593
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12087520/
Abstract

Benzodiazepines are a cornerstone in the treatment of alcohol withdrawal symptoms, although their use is associated with a risk of sedation leading to respiratory depression. This study describes the reasons for and frequency of Intensive Care Unit (ICU) admission, mechanical ventilation, and clinical outcomes for patients receiving symptom-triggered treatment with chlordiazepoxide for alcohol withdrawal symptoms. This retrospective quality-improvement study included admissions to a Danish general ICU after treatment with at least 200 mg chlordiazepoxide for alcohol withdrawal symptoms within 10 days before ICU admission. The primary outcome was the need for mechanical ventilation and secondary outcomes included 90-day hospital- and ICU readmission and mortality. The admissions were divided into two groups: "Too sedated" and "Too agitated" depending on the reason for ICU admission. A total of 113 patients with 133 admissions were included. The most common reasons for ICU admissions were respiratory insufficiency (39%) and somnolence (39%). Invasive or non-invasive mechanical ventilation was used in 71% of the ICU admissions (81% in the "Too sedated" and 53% in the "Too agitated" group, respectively). Thirty-six percent of admissions were followed by readmission to the hospital and 14% by readmission to the ICU within 90 days. Admissions were followed by a 21% risk of mortality at 90 days in the "Too sedated" group, whereas no patients died within 90 days in the "Too agitated" group. Typical presentation of ICU admission was respiratory insufficiency and somnolence after symptom-triggered treatment with chlordiazepoxide for alcohol withdrawal symptoms. Mechanical ventilation was used in more than two-thirds of the admitted patients, and the risk of readmission and fatal outcome was high.

摘要

苯二氮䓬类药物是治疗酒精戒断症状的基石,尽管其使用与镇静导致呼吸抑制的风险相关。本研究描述了接受氯氮䓬症状触发治疗酒精戒断症状的患者入住重症监护病房(ICU)、机械通气的原因和频率以及临床结局。这项回顾性质量改进研究纳入了在入住ICU前10天内接受至少200mg氯氮䓬治疗酒精戒断症状后入住丹麦普通ICU的患者。主要结局是机械通气的需求,次要结局包括90天内再次入院至医院和ICU以及死亡率。根据入住ICU的原因,将这些入院患者分为两组:“过度镇静”组和“过度躁动”组。共纳入113例患者的133次入院。入住ICU最常见的原因是呼吸功能不全(39%)和嗜睡(39%)。71%的ICU入院患者使用了有创或无创机械通气(“过度镇静”组为81%,“过度躁动”组为53%)。36%的入院患者在90天内再次入院至医院,14%在90天内再次入院至ICU。“过度镇静”组90天死亡率为21%,而“过度躁动”组90天内无患者死亡。接受氯氮䓬症状触发治疗酒精戒断症状后入住ICU的典型表现为呼吸功能不全和嗜睡。超过三分之二的入院患者使用了机械通气,再次入院和致命结局的风险很高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a89f/12087520/349d1033a80e/AAS-69-0-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a89f/12087520/5d622020fcf5/AAS-69-0-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a89f/12087520/5ca2497ff530/AAS-69-0-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a89f/12087520/349d1033a80e/AAS-69-0-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a89f/12087520/5d622020fcf5/AAS-69-0-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a89f/12087520/5ca2497ff530/AAS-69-0-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a89f/12087520/349d1033a80e/AAS-69-0-g003.jpg

相似文献

[1]
Respiratory Failure Requiring Mechanical Ventilation Among Patients Receiving Chlordiazepoxide for Alcohol Withdrawal Symptoms.

Acta Anaesthesiol Scand. 2025-7

[2]
Evaluation of a Symptom-triggered Protocol for Alcohol Withdrawal for Use in the Emergency Department, General Medical Wards, and Intensive Care Unit.

J Psychiatr Pract. 2019-1

[3]
A Symptom-Triggered Benzodiazepine Protocol Utilizing SAS and CIWA-Ar Scoring for the Treatment of Alcohol Withdrawal Syndrome in the Critically Ill.

Ann Pharmacother. 2017-2

[4]
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Medicine (Baltimore). 2018-4

[5]
Impact of a Divided Phenobarbital Load and Taper Compared With Lorazepam Symptom Triggered Therapy in Hospitalized Patients.

Ann Pharmacother. 2024-9

[6]
The Safety and Utility of Phenobarbital Use for the Treatment of Severe Alcohol Withdrawal Syndrome in the Medical Intensive Care Unit.

J Intensive Care Med. 2020-9

[7]
Outcome of children requiring admission to an intensive care unit after bone marrow transplantation.

Crit Care Med. 2003-5

[8]
Sedation in the ICU.

Dan Med J. 2012-5

[9]
Safety of Phenobarbital Versus Benzodiazepines for Alcohol Withdrawal in Critically Ill Patients With Primary Neurologic Injuries.

Ann Pharmacother. 2025-3

[10]
Prevalence of Patients Admitted to Intensive Care After Administration of Chlordiazepoxide in the Emergency Room.

Basic Clin Pharmacol Toxicol. 2025-4

本文引用的文献

[1]
A Narrative Review of Current and Emerging Trends in the Treatment of Alcohol Use Disorder.

Brain Sci. 2024-3-20

[2]
Eliminating the benzos: A benzodiazepine-sparing approach to preventing and treating alcohol withdrawal syndrome.

J Trauma Acute Care Surg. 2024-3-1

[3]
Beyond benzodiazepines: a meta-analysis and narrative synthesis of the efficacy and safety of alternative options for alcohol withdrawal syndrome management.

Eur J Clin Pharmacol. 2023-9

[4]
Alcohol withdrawal.

BMJ. 2023-5-31

[5]
Active chlordiazepoxide metabolites in a patient needing life support after treatment of alcohol abstinence.

Basic Clin Pharmacol Toxicol. 2020-11

[6]
Symptom-Triggered Therapy for Alcohol Withdrawal Syndrome: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

J Gen Intern Med. 2019-4-1

[7]
Evaluation of a Symptom-triggered Protocol for Alcohol Withdrawal for Use in the Emergency Department, General Medical Wards, and Intensive Care Unit.

J Psychiatr Pract. 2019-1

[8]
Continuous intravenous flumazenil infusion in a patient with chlordiazepoxide toxicity and hepatic encephalopathy.

J Emerg Trauma Shock. 2015

[9]
Recognition and management of withdrawal delirium (delirium tremens).

N Engl J Med. 2014-11-27

[10]
Alcohol use disorders increase the risk for mechanical ventilation in medical patients.

Alcohol Clin Exp Res. 2007-7

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