Riad Akkari, MD
Critical Care Fellow
George Washington University
Laurel, MD
Disclosure information not submitted.
Jeffrey Williams, MD
Assistant Professor of Anesthesiology and Critical Care Medicine
George Washington University Hospital, United States
Disclosure information not submitted.
Matthew McMullan, M.D.
Assistant Professor
Medstar Washington Hospital Center
Washington, District of Columbia, United States
Disclosure information not submitted.
Azuka Nwude, PharmD, RPh
Critical Care Pharmacist
George Washington University Hospital, United States
Disclosure information not submitted.
David Yamane, BS, MD
Assistant Professor of Emergency Medicine, Anesthesiology, and Critical Care Medicine
George Washington University Hospital, United States
Disclosure information not submitted.
Susan Kartiko, MD, PhD
Assistant Professor of Surgery
George Washington University School of Medicine and Health Sciences, United States
Disclosure information not submitted.
Title: Phenobarbital in Alcohol Withdrawal Offers Better Outcomes Vs Dexmedetomidine + Benzodiazepine Alone
Introduction: Severe alcohol withdrawal syndrome (AWS) can be fatal, even in a hospital setting. Historically, benzodiazepines have been the mainstay of treatment for alcohol withdrawal syndrome. However treatment of AWS with benzodiazepines is associated with respiratory failure, ICU admission and prolonged hospital course. Phenobarbital and dexmedetomidine have been used recently as adjuncts to AWS treatment to reduce benzodiazepine requirement in AWS patients. However comparison between the usages of the two medications has not been thoroughly explored. Here we studied the efficacy of phenobarbital addition in AWS treatment compared to dexmedetomidine and benzodiazepine.
Methods: We performed a retrospective chart review of patients with AWS from January 2020 to July 2021 at a single academic medical center. AWS is diagnosed by clinicians and treated based on CIWA. We compared the outcomes of patients with continuous dexmedetomidine infusion and benzodiazepines (DEX+) versus patients who received phenobarbital along with other adjuncts including dexmedetomidine and benzodiazepine (PHENO+). We collected patients’ demographic information, comorbid diagnoses, and outcome data.
Results: 156 patients who were included in this analysis, 102 treated with dexmedetomidine and benzodiazepine, and 54 had phenobarbital in their treatment plan. The two groups are not significantly different in age and gender composition. Comparing the PHENO+ versus DEX+ groups, we found a significantly shorter hospital length of stay (6 vs. 9 days (p< 0.05)) and lower ICU admission rate (35% vs. 100% (p< 0.05)). However once admitted, the median ICU LOS for both group is 4 days. The intubation rate was lower in PHENO+ patients (28% vs 47%, p< 0.05). However, once intubated, PHENEO+ patients trended to have longer mechanical ventilation days (3.75 vs 2.06, P=0.067). The median maximum CIWA score for PHENO+ patients are 17 while DEX+ is 15 (P=0.53).
Conclusions: The use of phenobarbital in AWS treatment plan may reduce hospital LOS and ICU admission and intubation rate when compared to AWS treatment plan with dexmedetomidine and benzodiazepine alone. Further prospective studies should be performed to evaluate the utility of phenobarbital in severe alcohol withdraw to improve critical care outcomes.