Michaelia Cucci, BCCCP, BCPS, PharmD
Clinical Pharmacy Specialist- Surgical/Trauma ICU
Cleveland Clinic Akron General
Akron, Ohio
Disclosure information not submitted.
Nicole Palm, BCCCP, PharmD
Clinical Pharmacy Specialist
Cleveland Clinic Main Campus
Cleveland, Ohio
Disclosure information not submitted.
Daniel Vazquez, MD
Medical Director, Surgical Intensive Care Unit
n/a, United States
Disclosure information not submitted.
Chanda Mullen, PhD
Research Coordinator
Cleveland Clinic Akron General, United States
Disclosure information not submitted.
.jpg "Mojdeh Heavner, BCCCP, BCPS, PharmD photo")
Mojdeh Heavner, BCCCP, BCPS, PharmD
Associate Professor and Vice Chair for Clinical Services
University of Maryland School of Pharmacy
Baltimore, MD
Disclosure information not submitted.
Title: National Survey of Critical Care Practices for Alcohol Withdrawal Syndrome in the ICU Setting
Introduction/Hypothesis: Alcohol use disorder affects up to 31% of intensive care unit (ICU) patients and alcohol withdrawal syndrome (AWS) is associated with increased length of stay, time on mechanical ventilation, and mortality. The lack of clinical practice guidelines for ICU patients lends to various AWS practice patterns in this population. The aim of this study was to describe current practice patterns employed in the treatment of AWS in various ICU settings across the United States.
Methods: This was a cross-sectional survey of practicing critical care pharmacists identified via a pharmacy professional organization critical care listserve. Emails were sent four times to the recipient list from May 14, 2021 to June 25, 2021. Retired pharmacists and trainees on the listserve were excluded. The survey was created and analyzed using REDCap.
Results: There was a total of 142/1534 (9.3%) responses. A total of 482 were excluded for being a trainee (n=474, 23.5%) or retired (n=8, 0.4%). Predominant characteristics included university hospital practice (n=70, 49%) with greater than 75 ICU beds (n=54, 38%), and medical (n=53, 37%) or mixed (n=50, 35%) ICU populations. The majority reported having an ICU-specific institutional guideline (n=94, 68%). A total of 137 (97%) reported use of benzodiazepines, with lorazepam (n=134, 98%) as the preferred first-line treatment. Most use the agent as needed, rather than pre-emptively (n=131, 99%). Phenobarbital was reported to be utilized by 83% of respondents, primarily for treatment of benzo-refractory withdrawal. Similarly, dexmedetomidine was reported by 86% of respondents for refractory withdrawal. In intubated patients, 55% of respondents note propofol as the agent of choice. Regarding enteral therapies, clonidine is used by 46% and atypical antipsychotics by 33%.
Conclusions: Practice nationally varies; however, most pharmacists use symptom-triggered benzodiazepines first line for AWS in the ICU, followed by use of propofol intubated patients and dexmedetomidine and/or phenobarbital for refractory cases.