Christine Pham, PharmD, BCCCP
Emergency Medicine Pharmacist
Saint Joseph's University Medical Center
Paterson, NJ
Disclosure information not submitted.
Linda Chuang, PharmD, BCGP
Trauma-Surgical ICU Pharmacist
Cooper University Health Care, United States
Disclosure information not submitted.
Lauren Igneri, PharmD, BCCCP, BCPS,
Clinical Pharmacy Specialist - Critical Care
Cooper University Health Care
Camden, NJ
Disclosure information not submitted.
Anna Goldenberg-Sandau, DO
Trauma Surgeon
Cooper University Health Care, United States
Disclosure information not submitted.
Rachel Sensenig, MD
Director, Trauma Surgical Intensive Care Unit
Cooper University Health Care, United States
Disclosure information not submitted.
Terence Chau, BCCCP, BCPS, PharmD
Critical Care Pharmacist
Cooper University Hospital
Conshohocken, Pennsylvania
Disclosure information not submitted.
Diana Solomon, PharmD, BCCCP
Pharmacist
Cooper University Hospital
Camden, United States
Disclosure information not submitted.
Title: EVALUATION OF PHENOBARBITAL USE FOR THE MANAGEMENT OF ALCOHOL WITHDRAWAL IN CRITICALLY ILL PATIENTS
Introduction: While benzodiazepines remain as the standard of care approach to managing alcohol withdrawal syndrome (AWS), phenobarbital (PHB) is often utilized as an alternative agent in this setting. Critically ill patients represent a complex subset of patients who often present with risk factors for severe AWS in addition to oversedation. The objective of this study is to assess the safety and efficacy of PHB therapy for the management of AWS in patients admitted to both the medical intensive care unit (MICU) or trauma intensive care unit (TICU).
Methods: This is an IRB approved single-center, retrospective study conducted at a large academic medical center. Adults patients ≥ 18 years of age admitted to the MICU or TICU 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 (DTs), or seizures following initiation of PHB. Secondary outcomes included the incidence of oversedation (Richmond Agitation and Sedation Score ≤-2) and duration of mechanical ventilation within 24 hours of PHB administration.
Results: 84 patients were included in this study. 24 patients were admitted to the MICU, and 60 patients were admitted to the TICU. While trauma patients commonly presented with elevated blood alcohol levels on admission, levels in MICU patients were typically undetectable. Average loading dose was 8.3 ± 4.2 mg/kg and 11.3 ± 2.5 mg/kg of ideal body weight in MICU and TICU patients, respectively. Average cumulative dose of PHB administered was 18.4 ± 9.8 mg/kg IBW over a median duration of 117.8 hours in MICU patients and 22.0 ± 13.2 mg/kg IBW over a median of 139 hours in TICU patients. AWSRC were reported in 67.9% of patients in the study, but there was no significant difference in rates between MICU and TICU patients. Among MICU patients, the incidence of oversedation was significantly higher, and the median duration of mechanical ventilation was 2.5 times that of TICU patients.
Conclusion: Patients admitted to the MICU experience significantly higher rates of oversedation following initiation of PHB therapy compared to trauma patients. Future research is needed to identify predictors for oversedation and severe AWS among MICU and TICU patients.