Continuous Propofol Infusion in Nonmechanically Ventilated Patients With Refractory Alcohol Withdrawal

Abstract

SESSION TITLE: Non Pulmonary Critical CareSESSION TYPE: Original Investigation SlidePRESENTED ON: Monday, October 28, 2013 at 07:30 AM - 09:00 AMPURPOSE: Compare the safety and efficacy of continuous propofol infusion (CPI) in non-mechanically ventilated patients to standard treatment (ST) for the management of refractory alcohol withdrawal syndrome or delirium tremens.METHODS: Retrospective chart review of all patients admitted to a multi-disciplinary intensive care unit (ICU) affiliated with an acute drug and alcohol detoxification center with a discharge diagnosis related to alcohol withdrawal syndrome between January 1, 2006 to December 31, 2011. ST was defined as any treatment other than CPI use pre-intubation and included benzodiazepines, narcotics and neuroleptics. CPI and ST patients were compared for hospital mortality, need for mechanical ventilation (MV), duration of MV, length of stay (LOS) and medication usage.RESULTS: We reviewed 552 patients. CPI was initiated on 98 patients, where 70 patients (71%) avoided MV and 24 were intubated with a hospital mortality of 1.43% and 29.17% respectively (p<0.001). In the ST group (n=454), 312 patients (69%) avoided MV while 140 were intubated with a mortality of 6.94% and 30.28% respectively (p<0.001). There was no statistical difference for in-hospital mortality when comparing CPI to ST. There were no statitical differences in the use of benzodiazepines nor opiates in the CPI ventilated and non-ventilated groups. Propofol dose in the CPI group averaged 59.1 (+/- 34.6 SD) mcg/kg/min.CONCLUSIONS: In this single center retrospective study, CPI for refractory alcohol withdrawal in non-mechanically ventilated patients is shown to be safe and non-inferior to ST. MV is associated with a profound increased mortality in both groups.CLINICAL IMPLICATIONS: Continuous propofol infusion for refractory alcohol withdrawal can be safe. It is not yet clear if it may be more efficacious than ST. Avoidance of mechanical ventilation improves survival. The authors hypothesize that the titratable sedation provided by Propofol may have a future superior to ST at avoiding this endpoint. Further validation with prospective randomized controlled trials would be warranted.DISCLOSURE: The following authors have nothing to disclose: F. Maguire, Russ Acevedo, David Landsberg, Dan Polacek, Lynette Johnson, Andrea CallNo Product/Research Disclosure Information