Calming the Storm: Adjunctive Dexmedetomidine for Alcohol Withdrawal Delirium: A Retrospective Comparative Study

Background: Alcohol Withdrawal Delirium (Delirium Tremens, DT) is a severe and potentially fatal complication of alcohol dependence requiring intensive medical care. Benzodiazepines are the standard treatment, but high doses can cause respiratory depression and may require ventilation. Dexmedetomidine offers sedation without respiratory suppression and can serve as a useful adjunct. We aimed to compare clinical outcomes between patients of Alcohol Withdrawal Delirium receiving standard treatment alone and those receiving adjunctive Dexmedetomidine infusion. Methods: This retrospective observational study analyzed medical records of patients admitted with Alcohol Withdrawal Delirium between January 2023 and June 2024. Patients were assigned to either: (1) Standard of Care (SOC) with benzodiazepine-based detoxification, or (2) Adjunctive Dexmedetomidine infusion (DEX group). Baseline characteristics and outcomes such as ICU stay duration, benzodiazepine requirements, haloperidol use, and complications were compared. Results: Outcomes included ICU stay, benzodiazepine and haloperidol use, and complications. Of 44 patients (SOC = 30; DEX = 14), baseline severity was similar. The DEX group showed shorter ICU stay (46.9 vs 52.7 hrs), reduced benzodiazepine duration (10.7 vs 11.5 days) and first-day dose (227 vs 263 mg), and lower PRN haloperidol use (2.7 vs 5.8 mg). Peak agitation (RASS) was lower in DEX (+2.7 vs +3.2). Aspiration pneumonia occurred only in SOC (2 cases). Conclusion: Adjunctive Dexmedetomidine appears to improve clinical outcomes in Alcohol Withdrawal Delirium by reducing agitation and sedative load without increasing respiratory risk. It represents a useful addition to standard benzodiazepine-based detoxification protocols.