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01-12-2003 | Original

Alcohol withdrawal severity is decreased by symptom-orientated adjusted bolus therapy in the ICU

Authors: Claudia D. Spies, Hilke E. Otter, Bernd Hüske, Pranav Sinha, Tim Neumann, Jordan Rettig, Erika Lenzenhuber, Wolfgang J. Kox, Edward M. Sellers

Published in: Intensive Care Medicine | Issue 12/2003

Abstract

Objective

To examine the effect of bolus vs. continuous infusion adjustment on severity and duration of alcohol withdrawal syndrome (AWS), the medication requirements for AWS treatment, and the effect on ICU stay in surgical intensive care unit (ICU) patients.

Design and setting

Prospective randomized, double-blind controlled trial in a surgical ICU.

Patients

44 patients who developed AWS after admission to the ICU.

Interventions

Patients were randomized to either (a) a continuous infusion course of intravenous flunitrazepam (agitation), intravenous clonidine (sympathetic hyperactivity), and intravenous haloperidol (productive psychotic symptoms) if needed (infusion-titrated group), or (b) the same medication (flunitrazepam, clonidine, or haloperidol) bolus adjusted in response to the development of the signs and symptoms of AWS (bolus-titrated group).

Measurements and results

The administration of “as-needed” medication was determined using a validated measure of the severity of AWS (Clinical Institute of Withdrawal Assessment). Although the severity of AWS did not differ between groups initially, it significantly worsened over time in the infusion-titrated group. This required a higher amount of flunitrazepam, clonidine, and haloperidol. ICU treatment was significantly shorter in the bolus-titrated group (median difference 6 days) due to a lower incidence of pneumonia (26% vs. 43%).

Conclusions

We conclude that symptom-orientated bolus-titrated therapy decreases the severity and duration of AWS and of medication requirements, with clinically relevant benefits such as fewer days of ventilation, lower incidence of pneumonia, and shorter ICU stay.

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Title: Alcohol withdrawal severity is decreased by symptom-orientated adjusted bolus therapy in the ICU
Authors: Claudia D. Spies
Hilke E. Otter
Bernd Hüske
Pranav Sinha
Tim Neumann
Jordan Rettig
Erika Lenzenhuber
Wolfgang J. Kox
Edward M. Sellers
Publication date: 01-12-2003
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 12/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-003-2033-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Alcohol withdrawal severity is decreased by symptom-orientated adjusted bolus therapy in the ICU

Abstract

Objective

Design and setting

Patients

Interventions

Measurements and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design and setting

Patients

Interventions

Measurements and results

Conclusions

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