Background: Alcohol withdrawal syndrome (AWS) affects 31% of ICU patients and leads to notable increases in morbidity and mortality. Current first line management typically involves the use of benzodiazepines (BZD), though historically, therapeutic ethanol (EtOH) was often used. Concerns surrounding the side effect profile of BZD, combined with the continued use of EtOH in the setting of AWS, have sparked renewed interest in therapeutic EtOH. This review analyzes the recent literature surrounding the use of EtOH in patients suffering from AWS in the intensive care unit (ICU) setting.
Methods: An extensive search was performed using the databases EBMR, MEDLINE-Ovid, and Web of Science. The following keywords were used: alcohol, withdrawal, ethanol, delirium, and seizure. The search also necessitated studies to have at least one of the following terms: intensive care unit, ICU, inpatient, trauma, or critical care. The results were then reviewed for quality based on GRADE criteria.
Results: The query above generated 494 results that were reviewed for relevancy. Two studies met inclusion criteria, both of which were non-blinded, randomized, controlled trials with patients being treated for AWS in the ICU using EtOH. One study found mild benefit to using EtOH, while the other study found current therapy with BZD to be superior. Quality of the studies was either low or very low according to GRADE profile.
Conclusion: It is unclear whether patients benefit from EtOH, either as an adjunct or as mono-therapy, in the management of AWS compared to use of BZD. More research is needed to determine the efficacy of therapeutic EtOH.
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