Abstract
Introduction
While benzodiazepines (BZD) are the standard of care therapy for the management alcohol
withdrawal syndrome (AWS), phenobarbital (PHB) is often used as an alternative agent.
The objective of this study is to assess the use of PHB therapy for the management
of AWS in trauma-surgical intensive care unit (TSCU) patients.
Materials and methods
This is an institutional review board–approved single-center, retrospective study
conducted at a large academic medical center. Patients aged ≥ 18 y admitted to the
TSCU receiving PHB therapy for primary management of AWS were included. The primary
outcome evaluated was the incidence of AWS-related complications (AWSRC) defined as
severe agitation, delirium tremens, or seizures following initiation of PHB. Secondary
outcomes included the incidence of oversedation and duration of mechanical ventilation.
Results
Sixty patients were included in this study. AWSRC following initiation of PHB occurred
in 65% of patients. Median time to initiation of PHB (42 versus 18 h, P = 0.001) and rates of oversedation (79.5% versus 28.6%, P < 0.001) were significantly greater among patients who experienced AWSRC compared
to those who did not. Univariate analysis revealed use of BZD therapy for ≥ 24 h prior
to PHB initiation, time from hospital admission to PHB initiation ≥ 24 h, presence
of AWS symptoms at baseline, and baseline MINDS score > 6 were risk factors for AWSRC.
Conclusions
Delays in initiation of PHB appear to be associated with an increased risk for developing
AWSRC. Further research is needed to identify an optimal dosing strategy for TSCU
patients at high risk for severe AWS.
Keywords
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Article info
Publication history
Published online: December 09, 2022
Accepted:
November 16,
2022
Received in revised form:
November 9,
2022
Received:
April 22,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
