Treatment of Alcohol Withdrawal Syndrome: Phenobarbital vs CIWA-Ar Protocol
- 1 November 2018
- journal article
- research article
- Published by AACN Publishing in American Journal of Critical Care
- Vol. 27 (6), 454-460
- https://doi.org/10.4037/ajcc2018745
Abstract
Background Benzodiazepine-based therapy for alcohol withdrawal is associated with agitation and respiratory depression. Treatment can be complicated by a need for adjunctive therapy to control these symptoms and in patients requiring mechanical ventilation. Strong evidence for the effectiveness of alternative treatment modalities is lacking, despite the availability of promising pharmacological agents such as phenobarbital. Objective To compare the standard of care for the treatment of alcohol withdrawal—a symptom-triggered benzodiazepine protocol used in conjunction with the revised Clinical Institute Withdrawal Assessment of Alcohol (CIWA-Ar) scale—with a phenobarbital protocol. Methods Retrospective cohort study conducted from January 2016 through June 2017 at a 42-bed medical intensive care unit in a private teaching hospital in Nashville, Tennessee. The primary outcome was intensive care unit length of stay. Secondary outcomes included hospital length of stay, incidence of invasive mechanical ventilation, and use of adjunctive pharmacotherapy. Results Patients who received phenobarbital had significantly shorter stays in the intensive care unit than did those who received therapy based on the CIWA-Ar scale (mean [SD], 2.4 [1.5] vs 4.4 [3.9] days; P < .001). Those who received phenobarbital also had significantly shorter hospital stays (4.3 [3.4] vs 6.9 [6.6] days; P = .004). The incidence of invasive mechanical ventilation was lower in the phenobarbital group (1 [2%] vs 14 [23%] patients; P < .001), as was use of adjunctive agents for symptom control, including dexmedetomidine (4 [7%] vs 17 [28%] patients; P = .002). Conclusion A phenobarbital protocol for the treatment of alcohol withdrawal is an effective alternative to the standard-of-care protocol of symptom-triggered benzodiazepine therapy.Keywords
This publication has 9 references indexed in Scilit:
- Treatment of Severe Alcohol WithdrawalAnnals of Pharmacotherapy, 2016
- Epidemiology ofDSM-5Alcohol Use DisorderJAMA Psychiatry, 2015
- Alcohol withdrawal syndrome in critically ill patientsThe Journal of Trauma and Acute Care Surgery, 2014
- A Randomized, Double-Blind, Placebo-Controlled Dose Range Study of Dexmedetomidine as Adjunctive Therapy for Alcohol Withdrawal*Critical Care Medicine, 2014
- Phenobarbital for Acute Alcohol Withdrawal: A Prospective Randomized Double-blind Placebo-controlled StudyThe Journal of Emergency Medicine, 2013
- Alcohol withdrawal and delirium tremens in the critically ill: a systematic review and commentaryIntensive Care Medicine, 2012
- A prospective, randomized, trial of phenobarbital versus benzodiazepines for acute alcohol withdrawalThe American Journal of Emergency Medicine, 2010
- The Interaction of the Neuroprotective Compounds Riluzole and Phenobarbital with AMPA-Type Glutamate Receptors: A Patch-Clamp StudyPharmacology, 2009
- A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens*Critical Care Medicine, 2007