Intensive Care Medicine

, Volume 29, Issue 12, pp 2230–2238 | Cite as

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

  • Claudia D. SpiesEmail author
  • Hilke E. Otter
  • Bernd Hüske
  • Pranav Sinha
  • Tim Neumann
  • Jordan Rettig
  • Erika Lenzenhuber
  • Wolfgang J. Kox
  • Edward M. Sellers



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.


44 patients who developed AWS after admission to the ICU.


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%).


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.


Alcohol withdrawal syndrome Symptom-orientated therapy Surgical intensive care unit Clinical Institute of Withdrawal Assessment Critically ill patients Pneumonia 



We are most grateful to our statistician Dipl.-Math Gerda Siebert, Institute of Medical Biometrics, Department of Medical Statistics, Charité Medical Center, Humboldt University of Berlin.

Supplementary material

134_2003_2033_MOESM1_ESM.pdf (30 kb)
Supplementary material (PDF 30 KB)


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Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Claudia D. Spies
    • 1
    Email author
  • Hilke E. Otter
    • 1
  • Bernd Hüske
    • 1
  • Pranav Sinha
    • 2
  • Tim Neumann
    • 1
  • Jordan Rettig
    • 3
  • Erika Lenzenhuber
    • 4
  • Wolfgang J. Kox
    • 1
  • Edward M. Sellers
    • 5
  1. 1.Department of Anesthesiology and Intensive Care MedicineCharité-Universitätsmedizin Berlin, Campus Charité MitteBerlinGermany
  2. 2.Institute of Clinical ChemistryCharité-Universitätsmedizin BerlinBerlinGermany
  3. 3.School of MedicineUniversity of ConnecticutUSA
  4. 4.Department of Anesthesiology and Intensive Care MedicineCharité-Universitätsmedizin Berlin, Campus Benjamin Franklin BerlinGermany
  5. 5.Departments of Pharmacology, Medicine, and PsychiatryUniversity of TorontoTorontoCanada

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