Characterization of Intravenous Ethanol Use for Alcohol Dependent Patients in an Intensive Care Unit

Background: Little evidence supports intravenous ethanol (IVE) as an alternative alcohol withdrawal syndrome (AWS) prophylactic agent. This study characterized the use of IVE in alcohol dependent patients and described clinically relevant efficacy and safety outcomes.Methods: Retrospective descriptive study of IVE use between January ۱st, ۲۰۱۱ and September ۱۵th, ۲۰۱۸ was carried out in this study. Patient characteristics, infusion parameters, and outcomes were recorded.                                  Results: In this study, ۶۹ patients received IVE; ۲۴ (۳۴.۸%) received IVE for AWS treatment. Percent infusion time outside goal Sedation-Agitation Scale (SAS) and Clinical Institute Withdrawal Assessment (CIWA) ranges were ۴.۸% (IQR ۰ – ۱۷.۴) and ۳.۸% (IQR ۰ – ۹.۸), respectively. Forty-two (۶۰.۹%) patients received a benzodiazepine with a median daily requirement of ۰.۷۲ mg (IQR ۰ – ۳.۱۲) of lorazepam equivalent. Mechanical ventilation was associated with increased benzodiazepine dose (p = ۰.۰۰۲) and a higher percentage of time spent outside goal SAS (p < ۰.۰۰۱) range. Treatment patients required higher daily doses of IVE (p = ۰.۰۵) and spent more time outside of goal CIWA range (p < ۰.۰۰۱). Higher initial infusion rate was associated with intubation during infusion. Conclusion: Patients spent a majority of infusion time within goal SAS and CIWA ranges and required low doses of benzodiazepines. Mechanical ventilation and indication were associated with significant differences in patient outcomes and are likely to be confounders for any future investigation utilizing benzodiazepine requirements or sedation or withdrawal scales as endpoints. Further study is required to elucidate the potential benefits and risks of IVE.

Keywords:

Withdrawal , prophylaxis , Critical care , Alcohol , Ethanol