AAST Releases Consensus Document on Preventing Alcohol Withdrawal Syndrome in Surgical ICU

Seshadri A, Appelbaum R, Carmichael SP, 2nd, et al. Prevention of Alcohol Withdrawal Syndrome in the Surgical ICU: An American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document. Trauma Surg Acute Care Open. 2022;7(1).

Alcohol withdrawal syndrome is defined as a set of symptoms, including nausea, vomiting, tremor, diaphoresis, agitation, disorientation, and others, that emerge in patients after cessation of alcohol intake. This condition is observed in up to 40% of at-risk patients admitted to surgical ICU care. In this report, the authors presented the recommendations contained in a Clinical Consensus Document created by the American Association for the Surgery of Trauma Critical Care Committee.

The consensus document recommended screening of patients with a history of alcohol use to determine risk for development of alcohol withdrawal syndrome using standard instruments such as the Alcohol Use Disorders Identification Test (AUDIT) and the Prediction of Alcohol Withdrawal Severity Scale (PAWSS). The features of the assessment instruments are clearly described in the report. Surveillance of at-risk patients using the Minnesota Detoxification Scale was recommended. Patients determined to be at high risk may be treated empirically with benzodiazepines or phenobarbital.

The consensus document provided useful discussions of alternative medications and discussed the history of intravenous alcohol use; the consensus panel recommended against the use of intravenous alcohol. Other helpful agents such as micronutrients were also discussed. Surgeons are urged to review the entire document.