Evaluation of Symptom-Triggered Benzodiazepines Versus Phenobarbital for Alcohol Withdrawal Syndrome in Trauma-Surgical Intensive Care Patients

Abstract

Background:

The standard of care for alcohol withdrawal syndrome (AWS) is symptom-triggered benzodiazepines. There is an interest in utilizing phenobarbital first line for AWS in trauma-surgical patients.

Objective:

The objective of this study was to compare a preemptive phenobarbital monotherapy protocol to symptom-triggered benzodiazepines for the prevention or treatment of AWS in the trauma-surgical patients.

Methods:

This was a single-center, retrospective study to evaluate the AWS standard of care for the Trauma Surgical Critical Care Service. Patients were divided into groups based on AWS protocol. The primary outcome was intensive care unit (ICU) length of stay (LOS). Secondary outcomes included: hospital mortality, hospital LOS, use of adjunctive agents for sedation, and incidence of mechanical ventilation rates.

Results:

A total of 514 patients were screened for eligibility, and 200 patients met inclusion criteria, with 100 patients being in each group. Patients who received the symptom-triggered benzodiazepine protocol had similar ICU LOS (median [IQR], 2.6 days [1.4-5.6 days] vs 2.9 days [1.8-4.7 days]; P = 0.4) and hospital LOS (8.1 days [3.9-16.9 days] vs 7.1 days [3.9-11.2 days]; P = 0.05) compared with the phenobarbital protocol. Hospital mortality was significantly lower in those who received phenobarbital (4% vs 14%; P = 0.02), as was use of adjunctive sedative agents (22% vs 46%; P < 0.001), and mechanical ventilation rates (9% vs 31%; P < 0.001) when compared with symptom-triggered benzodiazepines.

Conclusion and Relevance:

Trauma-surgical patients receiving phenobarbital for prevention or treatment of AWS had similar ICU and hospital LOS compared with symptom-triggered benzodiazepines. The use of a phenobarbital protocol was associated with lower mortality, mechanical ventilation, and adjunctive sedative medication use.