Intravenous ethanol for alcohol withdrawal syndrome in intensive care units

Introduction Although not often recommended, ethanol replacement is still used in hospitals, including ours. Since intravenous ethanol for alcohol withdrawal is mainly used in the intensive care units of our clinic, we reviewed literature to enable better liaison psychiatric consult for patients in this particular setting. Materials and methods We performed a MEDLINE search for pharmacological trials with alcohol dependent patients in intensive care units who were treated with, or who received intravenous ethanol as prophylaxis for alcohol withdrawal syndrome. Efficacy, eventual referral to addiction aid and postinterventional abstinence were chosen as outcome measures. If a withheld review article mentioned the search strategy, the search was carried forward from their end-date till ours in order to detect more recently published papers. In parallel, we initiated a small retrospective evaluation of our hospital’s electronic patient-records mentioning 96% ethanol 10ML ampoules. Results Retrospective analysis: Preliminary results indicate a rather anecdotic use of intravenous ethanol in our university hospital to prevent or treat alcohol withdrawal syndrome. Literature search: After our initial search, reference tracking and reproducing searches of relevant systematic reviews we identified 8 interventional trials. Those indicate, in accordance with recent systematic reviews, that intravenous ethanol is not more efficient than active control to prevent alcohol withdrawal syndrome. Numbers of referral to addiction aid and abstinence after discharge of patients was either unknown or low. Discussion Intravenous ethanol is not more efficient than active control to prevent alcohol withdrawal syndrome. Several reservations concerning methodology of trials on IVetOH use have been addressed. Consideration of a more unified study population (elective surgery vs. medical and trauma ICU patients) could be necessary. Ethical reflections and possible harm are also discussed. Conclusion In the selected interventional trials, intravenous ethanol was not superior to active control in preventing alcohol withdrawal syndrome. Furthermore, intravenous alcohol replacement is not advised due to its potential harm.