Use of propofol-containing versus benzodiazepine regimens for alcohol withdrawal requiring mechanical ventilation.

BACKGROUND: When chronic, excessive alcohol intake is abruptly halted, patients are at risk for developing life-threatening alcohol withdrawal syndrome (AWS). Benzodiazepines have established efficacy, yet some patients' symptoms persist despite treatment with high doses. OBJECTIVES: The study objective was to compare time to resolution of AWS symptoms in mechanically ventilated patients receiving propofol-containing versus benzodiazepine infusions. METHODS: This study was a retrospective cohort analysis of adult patients with ICD-9 codes for AWS who required mechanical ventilation for AWS symptoms. RESULTS: A total of 1637 records were reviewed, and 64 were included. Propofol-containing regimens were used in 46 cases (72%), whereas benzodiazepine infusion monotherapy accounted for 18 cases (28%). Patients were predominantly male (97%), with a mean age of 45 years. Lorazepam-equivalent benzodiazepine doses given prior to intubation were greater in patients receiving propofol infusion (56 vs 15 mg, P = .03). Time to resolution of AWS symptoms for propofol- and benzodiazepine-treated patients was 8 and 7 days, respectively (P = .34). Median hospital and intensive care unit lengths of stay were similar (9 vs 10 days and 4 vs 4 days, respectively; P > .05 for both comparisons), as were days of mechanical ventilation (4 vs 3 days, P = .98). Patients in the benzodiazepine infusion monotherapy group required numerically increased amounts of benzodiazepine bolus doses while on continuous sedation, compared with patients receiving propofol infusion (36 vs 10 mg, P = .06). CONCLUSIONS: Propofol and Benzodiazepine-treated patients with AWS requiring mechanical ventilation experienced similar days of AWS symptoms, length of stay, and mechanical ventilation.

Assessing chronic pain treatment practices and evaluating adherence to chronic pain clinical guidelines in outpatient practices in the United States.

UNLABELLED: Chronic pain is a major health concern in the United States. Several guidelines have been developed for clinicians to promote effective management and provide an analytical framework for evaluation of treatments for chronic pain. This study explores sample population demographics and the utilization of various therapeutic modalities in an adult population with common nonmalignant chronic pain (NMCP) indications in U.S. outpatient settings. A cross-sectional study using the National Ambulatory Medical Care Survey (NAMCS) data from 2000 to 2007 was used to analyze various treatment practices for the management of NMCP and evaluate the results in comparison with guidelines. The study population of 690,205,290 comprised 63% females, with 45.17% of patient visits occurring in primary care settings. Treatment with at least 1 chronic pain medication was reported in 99.7% of patients. Nonsteroidal anti-inflammatory agents were the most common treatment prescribed, with use reported in approximately 95% of the patient visits. No other pain medication drug class or nonmedication therapy was prescribed more than 26.4%. These results point to a potential underutilization of many recommended NMCP treatments including combination therapies and the need for enhanced education of chronic pain guidelines. PERSPECTIVE: This study, representing over 690 million patient visits, contributes to the relative paucity of data on the use of therapeutic modalities in the management of NMCP. These results may assist clinicians and healthcare policymakers in identifying areas where practices are at odds with guidelines with the goal to improve care.