Respiratory Failure Requiring Mechanical Ventilation Among Patients Receiving Chlordiazepoxide for Alcohol Withdrawal Symptoms

Benzodiazepines are a cornerstone in the treatment of alcohol withdrawal symptoms, although their use is associated with a risk of sedation leading to respiratory depression. This study describes the reasons for and frequency of Intensive Care Unit (ICU) admission, mechanical ventilation, and clinical outcomes for patients receiving symptom-triggered treatment with chlordiazepoxide for alcohol withdrawal symptoms. This retrospective quality-improvement study included admissions to a Danish general ICU after treatment with at least 200 mg chlordiazepoxide for alcohol withdrawal symptoms within 10 days before ICU admission. The primary outcome was the need for mechanical ventilation and secondary outcomes included 90-day hospital- and ICU readmission and mortality. The admissions were divided into two groups: "Too sedated" and "Too agitated" depending on the reason for ICU admission. A total of 113 patients with 133 admissions were included. The most common reasons for ICU admissions were respiratory insufficiency (39%) and somnolence (39%). Invasive or non-invasive mechanical ventilation was used in 71% of the ICU admissions (81% in the "Too sedated" and 53% in the "Too agitated" group, respectively). Thirty-six percent of admissions were followed by readmission to the hospital and 14% by readmission to the ICU within 90 days. Admissions were followed by a 21% risk of mortality at 90 days in the "Too sedated" group, whereas no patients died within 90 days in the "Too agitated" group. Typical presentation of ICU admission was respiratory insufficiency and somnolence after symptom-triggered treatment with chlordiazepoxide for alcohol withdrawal symptoms. Mechanical ventilation was used in more than two-thirds of the admitted patients, and the risk of readmission and fatal outcome was high.