Pharmacotherapeutic management of acute alcohol withdrawal syndrome in critically ill patients

Introduction Alcohol withdrawal syndrome is a common and life-threatening condition in patients suffering from alcohol use disorder. Treatment of this syndrome is challenging, especially in patients that are critically ill, either because of withdrawal symptoms or underlying conditions. For the treatment, several pharmacological agents exist, such as benzodiazepines, barbiturates, or dexmedetomidine. Nonetheless, as alcohol withdrawal syndromes can occur in every clinical setting, it is necessary to provide a guideline for clinicians confronted with this syndrome in varying clinical contexts.

Methods The authors provide a systematic review of the literature found in PubMed and Embase following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Thereby we tried to obtain an overview of pharmacological options for the treatment of alcohol withdrawal syndrome in the critically ill. For the systematic research, we used the following research term and applied it to “all fields”:(Alcohol withdrawal OR delirium tremens) AND (renal failure OR hepatic failure OR liver cirrhosis OR cardiac failure OR critical illness OR critical care OR intensive care)

Apart from this term, no other criteria were selected at this stage.

Results and Conclusion For the treatment of alcohol withdrawal syndrome, medications targeting the GABA system are preferred. Benzodiazepines are regarded as the gold standard. However, as many adjunct therapeutic options exist, it is essential to find symptom-triggered approaches and treatment protocols for the variety of clinical contexts. Apart from that, it is necessary to compare protocols towards clinical variables rather than investigating medications that are in use for the treatment of alcohol withdrawal syndrome.