PROPHYLAXIS OF ALCOHOL-WITHDRAWAL SYNDROME IN ALCOHOL-DEPENDENT PATIENTS ADMITTED TO THE INTENSIVE-CARE UNIT AFTER TUMOR RESECTION

Prophylaxis of alcohol withdrawal syndrome (AWS) in alcohol-dependent patients shortens the duration of stay in the intensive care unit (ICU ). The objective of this study was to assess the effect of four differ ent prophylactic regimens on the duration of ICU stay, prevention of A WS and rate of major intercurrent complications in alcohol-dependent p atients admitted to the ICU after tumour resection. A total of 197 alc ohol-dependent patients, diagnosed by the Diagnostic and Statistical M anual of Mental Disorders (third revised edition) with a daily ethanol intake of 60 g, were allocated randomly to one of the following regim ens which were commenced on admission to the ICU: flunitrazepam-clonid ine, chlormethiazole-haloperidol, flunitrazepam-haloperidol or ethanol . The duration of ICU stay, prevention of AWS, incidence of tracheobro nchitis and major intercurrent complications such as pneumonia, sepsis , cardiac disorders, bleeding disorders and death were documented. On admission, patients did not differ significantly in age, APACHE II and multiple organ failure scores. ICU stay, incidence of AWS, severity o f AWS (revised clinical institute withdrawal assessment for alcohol sc ale > 20) and major intercurrent complication rate did not differ sign ificantly between groups. Although there was no advantage in any of th e four regimens with respect to the primary outcome measures, pulmonar y and cardiac patients were not included in the study. Patients in the chlormethiazole-haloperidol group had a significantly increased incid ence of tracheobronchitis (P = 0.0023), probably because of an increas ed incidence of hypersecretion.