How effective is adjunctive dexmedetomidine for alcohol withdrawal in ICU patients?

In critically ill patients with alcohol withdrawal syndrome (AWS), adding dexmedetomidine to symptom-triggered benzodiazepines appears to cause no significant change in Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scores from baseline compared to symptom-triggered therapy alone, a recent study has found.

Patients with AWS admitted to an intensive care unit (ICU) were included in this single-centre, retrospective cohort study and divided into two groups: adjunctive dexmedetomidine or symptom-triggered therapy (control).

Change in CIWA-Ar score was the primary outcome, while the cumulative ICU benzodiazepine requirement and ICU/hospital length of stay (LOS) were secondary. Safety outcomes included incidence of adverse events, new-onset seizures, and intubation. The researchers also performed propensity score matching to minimize between-group differences.

A total of 147 patients were included: 56 in the dexmedetomidine group and 91 controls. Patient demographics were similar, but baseline CIWA-Ar score was statistically higher in the dexmedetomidine group. Fifty-five participants remained in each group after propensity matching.

Change in CIWA-Ar score did not significantly differ between groups (dexmedetomidine vs control: median, 3.8 vs 5.4; p=0.223). However, the dexmedetomidine group showed increased benzodiazepine requirements (p=0.001), prolonged ICU LOS (p=0.050), and more frequent use of physical restraints (p=0.001).

Development of new-onset seizures (p=0.775) and intubation (p=0.294) also occurred more frequently in the dexmedetomidine group, albeit not statistically significant.

“The increased rate of new onset seizures and intubation warrant further investigation into the safety of dexmedetomidine in AWS,” the researchers said.