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

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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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Acknowledgements

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.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Schumannstrasse 20/21, 10117, Berlin, Germany

    Claudia D. Spies, Hilke E. Otter, Bernd Hüske, Tim Neumann & Wolfgang J. Kox

  2. Institute of Clinical Chemistry, Charité-Universitätsmedizin Berlin, Berlin, Germany

    Pranav Sinha

  3. School of Medicine, University of Connecticut, Conn., USA

    Jordan Rettig

  4. Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin , Berlin, Germany

    Erika Lenzenhuber

  5. Departments of Pharmacology, Medicine, and Psychiatry, University of Toronto, Toronto, Ont., Canada

    Edward M. Sellers

Authors
  1. Claudia D. Spies
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  2. Hilke E. Otter
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  3. Bernd Hüske
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  4. Pranav Sinha
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  5. Tim Neumann
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  6. Jordan Rettig
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  7. Erika Lenzenhuber
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  8. Wolfgang J. Kox
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  9. Edward M. Sellers
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Corresponding author

Correspondence to Claudia D. Spies.

Additional information

This study was sponsored in part by the German Research Society (DFG-SP 432/1-1 and 1-2)

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Spies, C.D., Otter, H.E., Hüske, B. et al. Alcohol withdrawal severity is decreased by symptom-orientated adjusted bolus therapy in the ICU. Intensive Care Med 29, 2230–2238 (2003). https://doi.org/10.1007/s00134-003-2033-3

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  • DOI: https://doi.org/10.1007/s00134-003-2033-3

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