Use of propofol-containing versus benzodiazepine regimens for alcohol withdrawal requiring mechanical ventilation

Ann Pharmacother. 2014 Apr;48(4):456-61. doi: 10.1177/1060028013515846. Epub 2014 Jan 16.

Abstract

Background: When chronic, excessive alcohol intake is abruptly halted, patients are at risk for developing life-threatening alcohol withdrawal syndrome (AWS). Benzodiazepines have established efficacy, yet some patients' symptoms persist despite treatment with high doses.

Objectives: The study objective was to compare time to resolution of AWS symptoms in mechanically ventilated patients receiving propofol-containing versus benzodiazepine infusions.

Methods: This study was a retrospective cohort analysis of adult patients with ICD-9 codes for AWS who required mechanical ventilation for AWS symptoms.

Results: A total of 1637 records were reviewed, and 64 were included. Propofol-containing regimens were used in 46 cases (72%), whereas benzodiazepine infusion monotherapy accounted for 18 cases (28%). Patients were predominantly male (97%), with a mean age of 45 years. Lorazepam-equivalent benzodiazepine doses given prior to intubation were greater in patients receiving propofol infusion (56 vs 15 mg, P = .03). Time to resolution of AWS symptoms for propofol- and benzodiazepine-treated patients was 8 and 7 days, respectively (P = .34). Median hospital and intensive care unit lengths of stay were similar (9 vs 10 days and 4 vs 4 days, respectively; P > .05 for both comparisons), as were days of mechanical ventilation (4 vs 3 days, P = .98). Patients in the benzodiazepine infusion monotherapy group required numerically increased amounts of benzodiazepine bolus doses while on continuous sedation, compared with patients receiving propofol infusion (36 vs 10 mg, P = .06).

Conclusions: Propofol and Benzodiazepine-treated patients with AWS requiring mechanical ventilation experienced similar days of AWS symptoms, length of stay, and mechanical ventilation.

Keywords: alcohol withdrawal syndrome; benzodiazepines; delirium tremens; intensive care unit; mechanically ventilated; propofol; resolution of symptoms.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Benzodiazepines / therapeutic use*
  • Ethanol / adverse effects*
  • Female
  • Humans
  • Hypnotics and Sedatives / therapeutic use*
  • Length of Stay
  • Lorazepam / therapeutic use
  • Male
  • Middle Aged
  • Propofol / therapeutic use*
  • Respiration, Artificial*
  • Retrospective Studies
  • Substance Withdrawal Syndrome / drug therapy*

Substances

  • Hypnotics and Sedatives
  • Benzodiazepines
  • Ethanol
  • Lorazepam
  • Propofol