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Cited by 45Alcoholism and Thiamine DeficiencyAnesthesia and Sedative AgentsSubstance Abuse Treatment and Outcomes

The DOI matches its Crossref record; 14 of the 14 references it cites were found in a registry or an index.

Adjunct Ketamine Use in the Management of Severe Ethanol Withdrawal

Pizon, Anthony F., Lynch, Michael J., Benedict, Neal J., Yanta, Joseph H., Frisch, Adam, Menke, Nathan B., Swartzentruber, Greg S., King, Andrew M., Abesamis, Michael G., Kane-Gill, Sandra L.·2018·Critical Care Medicine
DOI 10.1097/ccm.0000000000003204
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Abstract

OBJECTIVES: Ketamine offers a plausible mechanism with favorable kinetics in treatment of severe ethanol withdrawal. The purpose of this study is to determine if a treatment guideline using an adjunctive ketamine infusion improves outcomes in patients suffering from severe ethanol withdrawal. DESIGN: Retrospective observational cohort study. SETTING: Academic tertiary care hospital. PATIENTS: Patients admitted to the ICU and diagnosed with delirium tremens by Diagnostic and Statistical Manual of Mental Disorders V criteria. INTERVENTIONS: Pre and post guideline, all patients were treated in a symptom-triggered fashion with benzodiazepines and/or phenobarbital. Postguideline, standard symptom-triggered dosing continued as preguideline, plus, the patient was initiated on an IV ketamine infusion at 0.15-0.3 mg/kg/hr continuously until delirium resolved. Based upon withdrawal severity and degree of agitation, a ketamine bolus (0.3 mg/kg) was provided prior to continuous infusion in some patients. MEASUREMENTS AND MAIN RESULTS: A total of 63 patients were included (29 preguideline; 34 postguideline). Patients treated with ketamine were less likely to be intubated (odds ratio, 0.14; p < 0.01; 95% CI, 0.04-0.49) and had a decreased ICU stay by 2.83 days (95% CI, -5.58 to -0.089; p = 0.043). For ICU days outcome, correlation coefficients were significant for alcohol level and total benzodiazepine dosing. For hospital days outcome, correlation coefficients were significant for patient age, aspartate aminotransferase, and alanine aminotransferase level. Regression revealed the use of ketamine was associated with a nonsignificant decrease in hospital stay by 3.66 days (95% CI, -8.40 to 1.08; p = 0.13). CONCLUSIONS: Mechanistically, adjunctive therapy with ketamine may attenuate the demonstrated neuroexcitatory contribution of N-methyl-D-aspartate receptor stimulation in severe ethanol withdrawal, reduce the need for excessive gamma-aminobutyric acid agonist mediated-sedation, and limit associated morbidity. A ketamine infusion in patients with delirium tremens was associated with reduced gamma-aminobutyric acid agonist requirements, shorter ICU length of stay, lower likelihood of intubation, and a trend toward a shorter hospitalization.

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Crossref · 10.1097/ccm.0000000000003204

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Metadata

Authors
Pizon, A. F., Lynch, M. J., Benedict, N. J., Yanta, J. H., Frisch, A., Menke, N. B., Swartzentruber, G. S., King, A. M., Abesamis, M. G., & Kane-Gill, S. L.
Affiliations
  • University of Pittsburgh (US)
  • Ohio Valley Medical Center (US)
  • Harrisburg Hospital (US)
  • Wayne State University (US)
  • Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA.
ORCID
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2018-08
Volume
46
Issue
8
Pages
e768-e771
ISSN
0090-3493 (ISSN-L)
DOI
10.1097/ccm.0000000000003204
OpenAlex
W2801229937
Cited by
45
References
14
Citations by year
2026: 5 · 2025: 10 · 2024: 6 · 2023: 3 · 2022: 7 · 2021: 4 · 2020: 7 · 2019: 3
FWCI
2.37
Type
journal article
Language
en
Open access
closed
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Clinical Neurology › Alcoholism and Thiamine Deficiency
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
ketamine, ethanol withdrawal, delirium tremens, adjunctive therapy, benzodiazepines, phenobarbital, NMDA receptor antagonism, intubation, ICU length of stay, alcohol detoxification, treatment guidelines, agitation, sedation requirements, liver enzymes, NMDA receptor antagonists
MeSH terms
Academic Medical Centers, Adult, Age Factors, Aged, Alcohol Withdrawal Delirium, Benzodiazepines, Drug Therapy, Combination, Female, Humans, Hypnotics and Sedatives, Intensive Care Units, Ketamine, Length of Stay, Liver Function Tests, Male, Middle Aged, Retrospective Studies, Severity of Illness Index, Excitatory Amino Acid Antagonists

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