Phenobarbital for the Management of Alcohol Withdrawal Syndrome in Critically Ill, Surgical-Trauma Patients

Pham, Christine; Goldenberg‐Sandau, Anna; Sensenig, Rachel; Chau, Terence; Igneri, Lauren; Solomon, Diana; Chuang, Linda Shyue Huey

doi:10.1016/j.jss.2022.11.029

Cited by 2 publications

(2 citation statements)

References 18 publications

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“…20 Another study of 60 patients receiving at least one dose of phenobarbital, initiated per provider discretion without protocol, suggested the time to initiation of phenobarbital was longer in patients with AWS-related complications. 21 Both trials lacked comparators, and support the use of a protocolized approach to phenobarbital use for AWS in the trauma population, such as in our study. A study of 85 surgical-trauma patients found that phenobarbital-treated patients were less likely to develop alcohol withdrawal delirium, uncomplicated AWS, or experience medication AEs compared to patients treated with a fixed-dose benzodiazepine-based protocol.…”

Section: Discussionsupporting

confidence: 70%

“…Two previous studies evaluated critically ill surgical-trauma patients receiving phenobarbital for AWS. 20,21 In a study of 31 patients receiving phenobarbital monotherapy, none of the patients developed AWS-related complications including seizures, alcoholic hallucinosis, or alcohol withdrawal delirium. 20 Another study of 60 patients receiving at least one dose of phenobarbital, initiated per provider discretion without protocol, suggested the time to initiation of phenobarbital was longer in patients with AWS-related complications.…”

Section: Discussionmentioning

confidence: 99%

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“Should We Phenobarb-it-All?” A Phenobarbital-Based Protocol for Non-Intensive Care Unit Trauma Patients at High Risk of or Experiencing Alcohol Withdrawal

Wang,

Falank,

Simboli

et al. 2024

The American Surgeon™

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Background Alcohol use is frequent in trauma patients and alcohol withdrawal syndrome (AWS) is associated with significant morbidity. Benzodiazepines are commonly used for AWS, but may cause neurologic and respiratory adverse events (AEs). The objective was to evaluate the effectiveness and safety of a phenobarbital-based protocol for the treatment of AWS in non-intensive care unit (ICU) trauma patients. Methods Adult non-ICU trauma patients at high risk of or experiencing AWS PRE and POST implementation of a phenobarbital-based protocol were included. Outcomes were AWS-related complications (AWS-RC), benzodiazepine use, adjunctive medication use, hospital length of stay (HLOS), and medication-related AEs. Subgroup analyses were performed on patients with traumatic brain injury (TBI), rib fractures, and at high risk of severe AWS. Results Overall, 110 patients were included (51 PRE, 59 POST). AWS-RC developed in 17 PRE patients compared to 10 POST patients (33% vs 17%; P = .05). PRE patients were more likely to receive benzodiazepines (88% vs 42%, P < .0001) and higher total dose (11 vs 4 mg lorazepam equivalent; P = .001). No difference noted in HLOS (8 vs 8 days, P = .27), adjunctive medication use (49% vs 54%, P = .60), or AEs (57% vs 39%, P = .06). There was no difference in AWS-RC in the TBI subgroup ( P = .19), less AEs in the rib fracture POST subgroup ( P = .04), and less AWS-RC in the high risk of severe AWS POST subgroup ( P = .03). Discussion A phenobarbital-based protocol in trauma patients is effective in preventing AWS-RC and decreasing benzodiazepine use without increasing AEs.

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Section: Discussionsupporting

confidence: 70%