Abstract
Objective: Current evidence supports symptom-triggered therapy for alcohol withdrawal syndrome (AWS). Early, escalating therapy with benzodiazepines (BZD) appears to decrease ICU length of stay (LOS); however, the effect on hospital LOS remains unknown. The hypothesis of this study is that focused BZD treatment in the first 24 h will decrease hospital LOS. Design: Pre–post cohort study. Setting: Academic medical center. Patients: This study included patients with severe AWS. The pre-intervention cohort (PRE) was admitted between January and November 2015. The post-intervention cohort (POST) was admitted between April 2016 and March 2017. Severe AWS was defined as patients requiring diazepam doses of >30 mg. Focused treatment was defined as >50% of total diazepam usage within the first 24 h of recognition of AWS. Intervention: In the PRE group, patients received symptom-triggered, escalating doses of diazepam and phenobarbital based on their Richmond Agitation-Sedation Scale (RASS). In the POST group, patients received a revised, time-limited course of therapy: escalating doses of BZD and phenobarbital were given during a 24-h loading phase, and all therapy was discontinued after a 72-h tapering phase. The SHOT scale was used as an adjunct to RASS to assess non-agitation symptoms of AWS and guide additional diazepam doses. Measurements and main results: The primary outcome was hospital LOS; secondary outcomes included ICU LOS, BZD use, and ventilator-free days. Five hundred thirty-two patients were treated using the AWS protocol; 113 experienced severe AWS. The PRE (n = 75) and POST (n = 38) groups were evenly matched in age, sex, history of AWS, and severity of illness. There was a substantial difference in POST patients who received focused treatment (51.3% vs. 73.7%, p =.03). The POST group had a significant decrease in hospital LOS (14.0 vs. 9.8 days, p =.03) and ICU LOS (7.4 vs. 4.4 days, p =.03). Conclusion: Early, focused management of severe AWS was associated with a decrease in ICU and hospital LOS.
| Original language | English (US) |
|---|---|
| Journal | Clinical Toxicology |
| DOIs | |
| State | Published - Jan 1 2019 |
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Keywords
- alcohol
- Alcohol withdrawal
- benzodiazepine
- critical care
- delirium
- phenobarbital
ASJC Scopus subject areas
- Toxicology
Cite this
Effect of early and focused benzodiazepine therapy on length of stay in severe alcohol withdrawal syndrome. / Lee, Jin A.; Duby, Jeremiah J.; Cocanour, Christine S.
In: Clinical Toxicology, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Effect of early and focused benzodiazepine therapy on length of stay in severe alcohol withdrawal syndrome
AU - Lee, Jin A.
AU - Duby, Jeremiah J.
AU - Cocanour, Christine S
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Objective: Current evidence supports symptom-triggered therapy for alcohol withdrawal syndrome (AWS). Early, escalating therapy with benzodiazepines (BZD) appears to decrease ICU length of stay (LOS); however, the effect on hospital LOS remains unknown. The hypothesis of this study is that focused BZD treatment in the first 24 h will decrease hospital LOS. Design: Pre–post cohort study. Setting: Academic medical center. Patients: This study included patients with severe AWS. The pre-intervention cohort (PRE) was admitted between January and November 2015. The post-intervention cohort (POST) was admitted between April 2016 and March 2017. Severe AWS was defined as patients requiring diazepam doses of >30 mg. Focused treatment was defined as >50% of total diazepam usage within the first 24 h of recognition of AWS. Intervention: In the PRE group, patients received symptom-triggered, escalating doses of diazepam and phenobarbital based on their Richmond Agitation-Sedation Scale (RASS). In the POST group, patients received a revised, time-limited course of therapy: escalating doses of BZD and phenobarbital were given during a 24-h loading phase, and all therapy was discontinued after a 72-h tapering phase. The SHOT scale was used as an adjunct to RASS to assess non-agitation symptoms of AWS and guide additional diazepam doses. Measurements and main results: The primary outcome was hospital LOS; secondary outcomes included ICU LOS, BZD use, and ventilator-free days. Five hundred thirty-two patients were treated using the AWS protocol; 113 experienced severe AWS. The PRE (n = 75) and POST (n = 38) groups were evenly matched in age, sex, history of AWS, and severity of illness. There was a substantial difference in POST patients who received focused treatment (51.3% vs. 73.7%, p =.03). The POST group had a significant decrease in hospital LOS (14.0 vs. 9.8 days, p =.03) and ICU LOS (7.4 vs. 4.4 days, p =.03). Conclusion: Early, focused management of severe AWS was associated with a decrease in ICU and hospital LOS.
AB - Objective: Current evidence supports symptom-triggered therapy for alcohol withdrawal syndrome (AWS). Early, escalating therapy with benzodiazepines (BZD) appears to decrease ICU length of stay (LOS); however, the effect on hospital LOS remains unknown. The hypothesis of this study is that focused BZD treatment in the first 24 h will decrease hospital LOS. Design: Pre–post cohort study. Setting: Academic medical center. Patients: This study included patients with severe AWS. The pre-intervention cohort (PRE) was admitted between January and November 2015. The post-intervention cohort (POST) was admitted between April 2016 and March 2017. Severe AWS was defined as patients requiring diazepam doses of >30 mg. Focused treatment was defined as >50% of total diazepam usage within the first 24 h of recognition of AWS. Intervention: In the PRE group, patients received symptom-triggered, escalating doses of diazepam and phenobarbital based on their Richmond Agitation-Sedation Scale (RASS). In the POST group, patients received a revised, time-limited course of therapy: escalating doses of BZD and phenobarbital were given during a 24-h loading phase, and all therapy was discontinued after a 72-h tapering phase. The SHOT scale was used as an adjunct to RASS to assess non-agitation symptoms of AWS and guide additional diazepam doses. Measurements and main results: The primary outcome was hospital LOS; secondary outcomes included ICU LOS, BZD use, and ventilator-free days. Five hundred thirty-two patients were treated using the AWS protocol; 113 experienced severe AWS. The PRE (n = 75) and POST (n = 38) groups were evenly matched in age, sex, history of AWS, and severity of illness. There was a substantial difference in POST patients who received focused treatment (51.3% vs. 73.7%, p =.03). The POST group had a significant decrease in hospital LOS (14.0 vs. 9.8 days, p =.03) and ICU LOS (7.4 vs. 4.4 days, p =.03). Conclusion: Early, focused management of severe AWS was associated with a decrease in ICU and hospital LOS.
KW - alcohol
KW - Alcohol withdrawal
KW - benzodiazepine
KW - critical care
KW - delirium
KW - phenobarbital
UR - http://www.scopus.com/inward/record.url?scp=85061195108&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85061195108&partnerID=8YFLogxK
U2 - 10.1080/15563650.2018.1542701
DO - 10.1080/15563650.2018.1542701
M3 - Article
C2 - 30729859
AN - SCOPUS:85061195108
JO - Clinical Toxicology
JF - Clinical Toxicology
SN - 1556-3650
ER -