(120) CIWA Versus MINDS in Alcohol Withdrawal Syndrome: A Retrospective Cohort Analysis

Introduction: Alcohol Withdrawal Syndrome (AWS) is primarily treated by symptom-triggered benzodiazepines. For many years, the Clinical Institute for Withdrawal Assessment (CIWA) protocol, based on subjective symptoms of AWS like agitation, tremor, and hallucinations, remained the mainstay of critical care symptom-triggered therapy. However, the Minnesota Detoxification Scale (MINDS) has grown in utilization in many intensive care units (ICU) because it includes more objective data like pulse and diastolic blood pressure to guide the use of benzodiazepines. There is limited research comparing CIWA versus MINDS protocols in the ICU. This study aims to compare clinical outcomes between the two protocols for patients in the ICU experiencing AWS.

Methods: This was a single-center, retrospective cohort analysis of patients treated with symptom-triggered benzodiazepines in the ICU using CIWA or MINDS protocol. Data was collected from January 2015 to December 2017 for the CIWA protocol group and January 2018 to January 2021 for the MINDS protocol group. The primary endpoint of this study was the duration of ICU length of stay (ICU LOS). Key secondary endpoints included cumulative midazolam equivalent use, mechanical ventilation, duration of mechanical ventilation, and in-hospital mortality.

Results: ICU LOS was a median of 2.87 days (IQR 1.76-6.20) in the MINDS protocol versus a median of 4.45 days (IQR 2.42-4.45) in the CIWA protocol (p=0.028). There were no significant differences found in the key secondary endpoints of benzodiazepine use (p=0.249), ventilation incidence (p=0.774), or ventilation duration (p=0.748). In-hospital mortality occurred more frequently in the CIWA compared to the MINDS protocol (p=0.003). Fewer patients in the MINDS protocol progressed to severe AWS than in the CIWA protocol group (p < 0.001).

Conclusions: This study found that MINDS resulted in a significantly shorter ICU LOS, less severe withdrawal, and less mortality compared to patients that received CIWA protocol without significant differences in benzodiazepine utilization. This emphasizes the clinical utility of the MINDS protocol over the CIWA protocol for AWS in the ICU.