Management du delirium tremens sous sédation continue par midazolam : étude rétrospective sur 11 ans

Abstract : Objective: Delirium tremens, the most severe form of alcohol withdrawal syndrome (AWS) is a common pathology that can be fatal. The objective of this study was to describe the complications and the risk factors in patients with AWS treated in intensive care unit (ICU) with continuous infusion of midazolam (MDZ) without systematic endotracheal intubation. Methods: We retrospectively reviewed the medical records of all patients hospitalized in St-Brieuc Hospital, for AWS between 2006 and 2016. Only those who received continuous infusion of MDZ and admitted in ICU, were included. Results: We studied 104 patients. The median age [interquartile range] was 49 [43-54] years. They have been treated by continuous infusion of MDZ during a median duration of 2 [1-3] days, with a median maximum velocity of 8 [5-12] mg/h. 13 patients (12%) developed respiratory complication (pneumonia and/or endotracheal intubation), and 8 (8%) had seizures. No cardiac arrest and no death was observed. The median ICU length of stay (LOS) was 3 [2-5] days. Patients who developed respiratory complication received more BZD (midazolam median total dose, 428 mg vs 147 mg in the non-respiratory complication group; p<0,001) and their ICU LOS was higher (median, 5 vs 3 days; p<0,001). The occurrence of respiratory complication was associated with a higher maximum infusion velocity of midazolam (>8mg/h) (OR=18.83, IC95% (2.11-168.15); p=0.009) and previous episodes of delirium tremens (OR=11.29, IC95% (1.45-87.60), p=0.02). Conclusion: Using continuous infusion of MDZ, including very large doses, for AWS treatment without endotracheal intubation in ICU, is not associated with a high morbidity and mortality.
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Master Thesis
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Renaud Haler. Management du delirium tremens sous sédation continue par midazolam : étude rétrospective sur 11 ans. Médecine humaine et pathologie. 2017. ⟨dumas-01624279⟩

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