(945) Evaluation of Alcohol Withdrawal Management in Mechanically Ventilated Patients in the TSICU

Introduction: Benzodiazepines (BZD) are the cornerstone of alcohol withdrawal syndrome (AWS) treatment. Symptom-triggered BZD therapy based on a validated measure of withdrawal severity is a common treatment strategy. A frequently used measure is the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar), however, it is dependent upon a patient’s ability to speak, thus limiting its accuracy in intubated patients. The Richmond Agitation Sedation Scale (RASS) is a validated scale used to measure the level of sedation in intubated patients. The purpose of this study is to compare symptom-triggered BZD therapy for AWS in mechanically ventilated patients utilizing a RASS score versus the CIWA-Ar scale.

Methods: This is a single-center, retrospective cohort study. Eligible patients for inclusion include mechanically ventilated patients 18 years of age or older admitted to the Trauma and Critical Care Surgery Service, who received BZD therapy for AWS. Patients were excluded if they were not admitted to the service, not intubated, receiving BZD prior to admission, left against medical advice within 24 hours, if the patient expired within 24 hours of admission, had a traumatic brain injury, or were pregnant. The primary outcome is ICU length of stay (LOS). Secondary outcomes include duration of mechanical ventilation, incidence of re-intubation, hospital LOS, cumulative BZD use, adjunct medications use, and in-hospital mortality.

Results: A total of 48 patients were included in this study, with 24 patients in the RASS group and 24 patients in the CIWA-Ar group. The median ICU LOS was 6 days in the RASS group and 9 days in the CIWA-Ar group (p-value 0.022). The median duration of intubation was 2.6 days in the RASS group and 5.7 days in the CIWA-Ar group (p-value 0.034). The median duration of overall hospital LOS was 16 days in the RASS group and 15 days in the CIWA-Ar group (p-value 0.033). No statistical difference was found in incidence of re-intubation, cumulative BZD use, use of adjunct medications, or in-hospital mortality.

Conclusions: Utilizing symptom-triggered BZD based on a RASS score to evaluate AWS in mechanically ventilated patients in comparison to the CIWA-Ar scale was associated with a significantly decreased duration of mechanical intubation and shorter ICU LOS.