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Health Science
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Jan 9, 2024
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docx
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Uploaded by ColonelHornet2361
Lawrence Albert Chang
MondayDec 18 at 9:36pm
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Clinical Issue
Alcohol is a commonly abused drug affecting 14.1 million adults in the US, and accounting for an estimated 9% - 33% of all intensive care unit (ICU) admissions. If not managed effectively, alcohol withdrawal syndrome (AWS) can progress to requiring mechnical ventilation, increasing the risk of additional complications (Collier, 2020). Benzodiazepines are currently recommended as the first-line treatment for AWS. However, the generous use of these medications increases the risk of adverse effects such as altered
mental status and respiratory depression.
Dexmedetomidine is a centrally acting a2-adrenergic receptor agonist with a rapid onset, short duration, and no significant side effect profile (Frazee, 2014). It is used adjunctively as a titratable continuous infusion in many institutions to reduce short-term alcohol withdrawal symptoms, used especially for its benzodiazepine-sparing effects. Evidence is still lacking regarding its overall utility compared to traditional therapy.
PICOT Question
What is the effectiveness of dexmedetomidine versus standard benziodiazpine therapy in treating severe alcohol withdrawal syndrome, as measured by both CIWA-Ar post-treatment scores and LOS in the ICU setting?
P
- What is the effectivess in treating severe alcohol withdrawal syndrome
I
- with dexmedetomidine
C
- versus standard benzodiazepine therapy
O
- as measured by both CIWA-Ar post-treatment scores and LOS
T
- for the duration of the ICU stay?
Database Search
Sage Journals: I used the Sage Journals database to search original research articles published within the last 10 years, using the phrase “dexmedetomidine alcohol withdrawal,” which yielded 91 results. I then added the phrase “versus benzodiazepines in the ICU,” which narrowed it to 34 results. Yet as I scrolled through the results, I noticed that many of the results were not about dexmedetomidine or alcohol withdrawal at all. Some were about phenobarbital, ketamine, baclofen, or various uses of dexmedetomidine such as for agitation or sedation.
Medline / CINAHL Plus: I searched the Medline/CINAHL database for peer-
reviewed research articles (again excluding reviews, meta-analyses, and case studies) published within the last 10 years, using a single phrase “dexmedetomidine alcohol withdrawal” in the first search bar—and received only 7 results. When I moved the phrase “alcohol withdrawal” to the second search bar, it yielded 25 results, which was unexpected.
Strategies to Improve Rigor
1.
Start with only the few essential key words or phrases that form the
basis of your question. If results are too broad, add aditional words that are specific to your PICOT question.
2.
Placing phrases in the second or third search bar—as opposed to lumping them all together in the top search bar—will return a broader selection of results. Play with this, and see what gives you the results you need.
3.
Both databases I searched could not effectively weed out systematic reviews and meta-analyses despite my selecting for only
research articles. It is important to review each result separately, even if it means just taking a quick read at the abstract.
4.
When searching articles regarding drugs, use the full generic names
of the drugs, not the brand names (e.g., dexmedetomidine versus Precedex).
References
Collier, T. E., Farrell, L. B., Killian, A. D., & Kataria, V. K. (2022). Effect of Adjunctive Dexmedetomidine in the Treatment of Alcohol Withdrawal Compared to Benzodiazepine Symptom-Triggered Therapy in Critically Ill Patients: The EvADE Study.
Journal of Pharmacy Practice
,
35
(3), 356–
362.
https://doi.org/10.1177/0897190020977755
Links to an external site.
Frazee, E. N., Personett, H. A., Leung, J. G., Nelson, S., Dierkhising, R. A., & Bauer, P. R. (2014). Influence of dexmedetomidine therapy on the management of severe alcohol withdrawal syndrome in critically ill patients.
Journal of Critical Care, 29
(2), 298-
302.
https://doi.org/10.1016/j.jcrc.2013.11.016
Links to an external site.
Reply
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