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Dexmedetomidine in addition to benzodiazepine-based sedation in patients with alcohol withdrawal delirium
Abstract
Alcohol withdrawal delirium (AWD) is often refractory to conventional medication. We report a prospective series of patients treated with α2-agonist dexmedetomidine added to conventional sedation. Eighteen patients with AWD were diagnosed by Confusion assessment method for ICU score. Treatment, complications, length of stay (LOS) in ICU and hospital were recorded. In addition, hospital and 1-year mortality were assessed. Dexmedetomidine was given for 23.9 (18.4) h [mean (SD)]. All the patients also received benzodiazepines but three patients were given haloperidole. No patient was intubated. The maximum infusion rate of dexmedetomidine was 1.5 (1.2) µg/kg/h. Time to resolution of AWD was 3.8 (1.3) days. The ICU LOS was 7.1 (2.7) days and in-hospital LOS 12.1 (4.5) days. No adverse events were observed although one patient died from acute pancreatitis. The use of dexmedetomidine in AWD seems safe but warrants further studies.
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In a study of dexmedetomidine as a second-line medication for severe alcohol withdrawal delirium, it prevented the need for anesthesia and intubation in all subjects.
“In the study, the use of dexmedetomidine as a second-line medication for severe alcohol withdrawal delirium, following local sedation protocol, prevented the need for anesthesia and intubation in all subjects [37].”
From A Narrative Review of Current and Emerging Trends in the Treatment of Alcohol Use Disorder (2024) · cites this paper as [37]
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“The use of adjunctive agents to BZDs, such as dexmedetomidine, phenobarbital, and propofol in AWS management has been studied, with variable results.(5-17) These agents target different mechanisms, including adrenergic symptoms and alternative GABA receptors.”
BackgroundMo, Y., Thomas, M. C., & Karras, G. E. (2016) · Journal of Critical Care · doi:10.1016/j.jcrc.2015.11.022 · Cited by 47
“Studies have suggested that dexmedetomidine as an adjunct in AWS may decrease alcohol withdrawal symptoms and benzodiazepine use, thereby potentially preventingmechanical ventilation [11,12].”
BackgroundBielka, K., Kuchyn, I. L., & Глумчер, Ф. С. (2015) · Annals of Intensive Care · doi:10.1186/s13613-015-0075-7 · Cited by 47
“However, most publications have been limited to case reports [14], case series [15] and retrospective [1] and prospective observational studies [16].”
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“Strategies studied to manage severe AWS include increasingly higher doses of BZDs, dexmedetomidine, phenobarbital, and propofol [9-20].”
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“Although case reports and retrospective cohorts suggest adjunctive DEX therapy decreases BZD requirements, these investigations are limited by the lack of a comparator control group and clinical outcomes.(8-15) One prospective, randomized, placebo-controlled, double-blind trial has been done evaluating the use of DEX…”
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“…[46] R ,D B N=159 IV CMZ + H vs F + H vs F + C/0.5–4.0 μg/kg/h F + C decr time on ventilator and incidence of pneumonia but higher cardiac complications Tolonen 2013 [54] O L N=10 IV LOR as needed + D/0.2–1.2 μg/kg/h 6–161 h infusion of D. NS reduction P and BP. Safe with benzodiazepines Frazee…”
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BackgroundWoods, A. D., Giometti, R., & Weeks, S. M. (2015) · JBI Database of Systematic Reviews and Implementation Reports · doi:10.11124/jbisrir-2015-1602 · Cited by 23
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Wujtewicz, M., Maciejewski, D., Misiołek, H., Fijałkowska, A., Gaszynski, T. M., Knapik, P., & Lango, R. (2014) · Anestezjologia, Intensywna Terapia · doi:10.5603/ait.2013.0045 · Cited by 23
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“Additionally, studies have shown a decrease in the rate of intubation due to high-dose benzodiazepine administration [5, 6, 8].”
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Wong, A., Smithburger, P. L., & Kane‐Gill, S. L. (2015) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952990.2015.1058390 · Cited by 22
“Resolution of delirium was defined as normalization of the RASS and the CAM-ICU, which were performed daily.”
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Wong, A. (2025) · Springer eBooks · doi:10.1007/978-3-031-77335-8_36 · Cited by 9
Puscas, M., Hasoon, M., Eechevarria, C., et al. (2016) · Journal of Addictive Diseases · doi:10.1080/10550887.2016.1164431 · Cited by 9
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Schwartzberg, D. M., & Shiroff, A. M. (2014) · Case Reports in Critical Care · doi:10.1155/2014/638493 · Cited by 3
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Perioperative management of patients with concomitant alcohol dependence. Guidelines
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DeMuro, J. P. (2013) · OA Alcohol · doi:10.13172/2053-0285-1-1-309 · Cited by 1
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Fahad, S., Maurya, A., Rozatkar, A. R., et al. (2025) · Indian Journal of Psychological Medicine · doi:10.1177/02537176251386921
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Metadata
- Authors
- Tolonen, J., Rossinen, J., Alho, H., & Harjola, V.-P.
- Affiliations
- Helsinki University Hospital (FI)
- Central Finland Health Care District (FI)
- Finnish Institute for Health and Welfare (FI)
- Corresponding author
- Tolonen, Jukka
- Venue
- European Journal of Emergency Medicine
- Published
- 2013-12
- Volume
- 20
- Issue
- 6
- Pages
- 425-427
- ISSN
- 0969-9546 (ISSN-L)
- OpenAlex
- W2019998710
- Cited by
- 45
- References
- 0
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 1 · 2019: 1 · 2018: 4 · 2017: 2 · 2016: 6 · 2015: 11 · 2014: 8 · 2013: 4
- FWCI
- 9.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Clinical Neurology › Alcoholism and Thiamine Deficiency
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Keywords
- dexmedetomidine, delirium tremens, benzodiazepine sedation, alpha-2 adrenergic agonists, ICU length of stay, mortality, acute pancreatitis, delirium management
- MeSH terms
- Adult, Aged, Alcohol Withdrawal Delirium, Benzodiazepines, Critical Care, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Therapy, Combination, Female, Finland, Follow-Up Studies, Humans, Hypnotics and Sedatives, Infusions, Intravenous, Intensive Care Units, Length of Stay, Male, Middle Aged, Prospective Studies, Severity of Illness Index, Cohort Studies, Procedural Sedation, Treatment Outcome, Risk Assessment, Dexmedetomidine
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