Safety of Dexmedetomidine Administered for Alcohol Withdrawal Syndrome to Nonintubated Icu Patients

ABSTRACT

INTRODUCTION: Dexmedetomidine is administrated in the ICU to treat adrenergic hyperactivity associated with alcohol withdrawal syndrome (AWS). Reduced ICU bed availability and drug shortages during the COVID-19 pandemic have spurred interest in mitigation strategies. The objective of this study was to develop preliminary data on the safety of dexmedetomidine when administered for AWS in nonintubated patients in order to develop a protocol for its use outside of the ICU. METHOD(S) Patients >=18 years of age admitted to an ICU for AWS and received dexmedetomidine between January 2020 and January 2022 were included. Patients were excluded if they required invasive mechanical ventilation or received dexmedetomidine for indications other than AWS. Bradycardia was defined as a heart rate < 40 beats per minute and hypotension as a systolic blood pressured < 80 mmHg. Heart block was identified using 12-lead electrocardiograms. Need for intervention for adverse drug effects was also recorded. Continuous data are reported as median (IQR) and nominal or categorical data as number (%). RESULT(S) Of the 204 patients screened, 148 (73%) were excluded for invasive mechanical ventilation and 8 (4%) for receipt of dexmedetomidine for non-AWS indications, leaving 48 (24%) evaluable patients. Most were male (n=36, 75%), white (n=43, 90%) and non-Hispanic/ Latino (n=47, 98%). Patients were bedded in the emergency department (n=20;42%), an intermediate care unit (n=11;23%), an outside hospital (n=10;21%), a general medical floor (n=6;12%), or perioperative unit (n=1, 2%) prior to ICU admission. The median initial dexmedetomidine dose was 0.35 (0.1, 0.5) mcg/kg/hr and the maximum dose was 1.2 (0.8, 1.4) mcg/ kg/hr. Time to the maximum dose was 2.2 (0.5, 8.5) hours and the total dexmedetomidine infusion duration was 25 (13, 40) hours. Hypotension occurred in 10 (21%) patients-only 2 (4%) required fluid administration, none received pressors or dose reduction. Bradycardia and heart block were not observed. CONCLUSION(S) Dexmedetomidine administration for AWS in non-intubated ICU patients was safely accomplished in 95% of patients with only 4% of the cohort developing hypotension requiring fluid administration. These results will be used to develop a protocol for dexmedetomidine administration in non-ICU areas for AWS.