Intensive Care Medicine

, Volume 39, Issue 1, pp 16–30 | Cite as

Alcohol withdrawal and delirium tremens in the critically ill: a systematic review and commentary

  • Don-Kelena Awissi
  • Genevieve Lebrun
  • Douglas B. Coursin
  • Richard R. Riker
  • Yoanna SkrobikEmail author



Alcohol withdrawal is common among intensive care unit (ICU) patients, but no current practice guidelines exist. We reviewed published manuscripts for prevalence, risk factors, screening tools, prophylactic and treatment strategies, and outcomes for alcohol withdrawal syndrome (AWS) and delirium tremens (DT) in the critically ill.


The following databases: PubMed, MEDLINE, Embase, Cochrane Database of Systematic Reviews and Central Register of Controlled Trials, CINAHL, Scopus, Web of Knowledge, pain, anxiety and delirium (PAD) Guidelines REFWORKS, International Pharmaceutical Abstracts and references for published papers were searched. Publications with high or moderate Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Oxford levels of evidence were included.


Reported AWS rates range from <1 % in ‘all ICU comers’ to 60 % in highly selected alcohol-dependent ICU patients. Alcohol dependence and a history of withdrawal are significant risk factors for AWS occurrence. No screening tools for withdrawal have been validated in the ICU. The benefit of alcohol withdrawal prophylaxis is unproven, and proposed regimens appear equivalent. Early and aggressive titration of medication guided by symptoms is the only feature associated with improved treatment outcome.


Treatment of AWS is associated with higher ICU complication rates and resource utilization. The optimal means of identification, prevention and treatment of AWS in order to establish evidence-based guidelines remain to be determined.


Alcohol withdrawal syndrome Delirium tremens Alcohol Critical care Intensive care Sedatives Withdrawal Delirium 



The authors wish to thank Odette Hinse, Hôpital Maisonneuve Rosemont, Dr Lavinius Alexander Ungur, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charite Berlin, Germany, for initial discussions in Oxford rating methodology, and Dr Claudia Spies for her support.

Conflicts of interest

No conflicts of interest to declare.

Supplementary material

134_2012_2758_MOESM1_ESM.doc (24 kb)
Supplementary material 1 (DOC 24 kb)
134_2012_2758_MOESM2_ESM.ppt (740 kb)
Supplementary material 2 (PPT 740 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2012

Authors and Affiliations

  • Don-Kelena Awissi
    • 1
  • Genevieve Lebrun
    • 1
  • Douglas B. Coursin
    • 2
  • Richard R. Riker
    • 3
  • Yoanna Skrobik
    • 4
    Email author
  1. 1.Pharmacy DepartmentHôpital Maisonneuve-RosemontMontrealCanada
  2. 2.Departments of Anesthesiology and MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  3. 3.Department of Critical Care Medicine, Maine Medical CenterTufts University School of MedicinePortlandUSA
  4. 4.Intensive Care UnitHôpital Maisonneuve-RosemontMontrealCanada

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