Manifestations and clinical course of delirium tremens in the ICU

Introduction

The aim of our study is to describe clinical progress, need for mechanical ventilation (MV), complications and mortality of patients with delirium tremens (DT) admitted to our ICU.

Methods

Patients with a diagnosis of DT admitted to a medical ICU of a tertiary hospital from January 2001 to December 2008 were included. We recorded: admission diagnosis, pathologies associated with DT, APACHE II score, treatment, need for MV and duration, complications, length of stay in the ICU and total hospital stay, mortality and survival at 2 years.

Results

There were 50 cases of DT. Median age 45 years, 96% male. Reasons for hospital admission: DT (68%), seizures (36%), sepsis (16%), brain injury (10%). Reasons for admission to the ICU: DT (54%), DT and seizures (26%), DT and brain injury (10%), DT and sepsis (8%), DT and other (2%). Median APACHE II score was 9 (range: 8 to 13). Seventy-four percent of the patients were controlled with no need for MV with a midazolam infusion of 45 to 50 μg/kg/hour and haloperidol of 17 to 30 μg/kg/hour. Twenty-eight per cent (14 patients) required MV, of them 78% had DT and other associated pathology on admission (Figure 1). From a total of 28 patients admitted with DT and no associated pathology, only four needed MV. The median time on MV was 2 days (range: 1 to 9). Complications were present in 22%: ventilation-associated pneumonia, and other infectious conditions. Total hospital length of stay 14 days ((SD: 11), 5.5 days in the ICU (SD: 9). The registered hospital mortality was 4%. Rate of survival at 2 years was 84%, from these 72% had continuous visits to emergency (≥5 consultations in 2 years) for episodes related to alcohol withdrawal or complications associated with chronic alcohol abuse.

Figure 1

Use of MV in patients admitted for DT.

Conclusions

Even though our patients with DT are frequently admitted to the ICU, this is a pathology that most of the time has a benign course with low hospital mortality and high rate of survival at 2 years. These patients are regular users of the health system. The occurrence of complications and the need for MV in our patients were low, and were present in the group of DT with other diagnoses.