Esma Enik, doctor of pharmacy
PHARMD
ST PETERSBURG GENERAL HOSPITAL, United States
Disclosure information not submitted.
Laurence Weiss, doctor of pharmacy
PHARMD
ST PETERSBURG GENERAL HOSPITAL, United States
Disclosure information not submitted.
Jesus Lanza, MEDICAL DOCTOR
MD
ST PETERSBURG GENERAL HOSPITAL, United States
Disclosure information not submitted.
Title: Phenobarbital for Alcohol Withdrawal in the ICU
Introduction: Phenobarbital potentiates GABA receptors, antagonizes NMDA receptors, and has a long half-life which reduces the need for adjunctive therapy. The purpose of this study is to compare the intensive care unit and hospital length of stay between a symptom triggered protocol using lorazepam and a high-dose phenobarbital protocol in managing alcohol withdrawal.
Methods: This retrospective study was done at a 21-bed medical ICU in a private community teaching hospital. The study included ICU patients admitted from January 1, 2018 through May 31, 2021. From January 1, 2018 through December 31, 2019 patients were treated with a symptom triggered protocol based on the CIWA scores for Alcohol Withdrawal. Patients were treated with phenobarbital loading dose of 10 mg/kg IV piggyback on Day 1, followed by an oral phenobarbital taper of 64.8 mg twice daily on Day 2, and phenobarbital 64.8 mg once daily on Day 3. On Day 1, at the provider’s discretion, patients could receive up to two additional “rescue” doses of phenobarbital 5 mg/kg IVPB if symptoms warranted with a maximum daily dose of 20 mg/kg in 24 hours. The primary study outcome was difference ICU and Hospital length of stay between the symptom triggered protocol and the phenobarbital protocol.
Results: A total of 91 encounters were included in the study. The mean ICU length of stay in the symptom triggered protocol group was 4.3 days and in the phenobarbital group was 2.9 days (95 percent CI 0.05 to 2.6, p = 0.002). The mean hospital length of stay in the symptom triggered protocol group was 7.6 days and in the phenobarbital group was 6.1 days (95 percent CI -0.6 to 3.5, p = 0.262). The mean IV phenobarbital loading dose was 10.9 mg/kg ideal body weight (standard deviation: 2.79). Nine patients (21.4%) received additional IV phenobarbital “rescue” doses for continued withdrawal symptoms after the initial loading dose.
Conclusion: Use of an IV phenobarbital loading dose with an oral phenobarbital taper had a lower ICU length of stay in patients admitted to a medical ICU with alcohol withdrawal symptoms, compared to patients treated with a symptom triggered protocol based on CIWA-Ar scores. . The phenobarbital protocol used in this facility has the benefit of a single IV loading dose of phenobarbital, with a two-day taper of oral phenobarbital.