Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA.
Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
J Intensive Care Med. 2020 Sep;35(9):844-850. doi: 10.1177/0885066618783947. Epub 2018 Jun 20.
Alcohol withdrawal syndrome (AWS) is a common reason for admission to a medical intensive care unit (MICU) and requires significant hospital resource utilization. Benzodiazepines are first-line therapy for AWS in many intensive care units. We propose the use of symptom-triggered phenobarbital for the treatment of AWS as a safe alternative to benzodiazepines.
This was a retrospective observational study of a 4-year period, 2011 to 2015, of all patients with AWS admitted to the MICU of 1 tertiary care hospital and treated with phenobarbital. A symptom-triggered protocol was used. Resolution of AWS was assessed with the Richmond Agitation Sedation Scale to goal score of 0 to -1. The Charlson Comorbidity Index was used as an index of patient illness severity. Complications associated with phenobarbital use and/or the AWS admission were analyzed.
Data of 86 AWS patient encounters were analyzed. The mean Clinical Institute Withdrawal Assessment for Alcohol-Revised score of patients admitted to the MICU with AWS was 19 ± 9. The mean phenobarbital dose administered during the MICU stay was 1977.5 ± 1531.5 mg. There were a total of 17 (20%) intubations. The most frequent cause of mechanical ventilation in patients with AWS was loss of airway clearance, followed by hemodynamic instability secondary to upper gastrointestinal bleeding and the corresponding need for endoscopy.
Sole use of phenobarbital use for control of AWS may be a safe alternative to benzodiazepines. Further study is needed to correlate phenobarbital serum levels with clinical control of AWS.
酒精戒断综合征（AWS）是入住医疗重症监护病房（MICU）的常见原因，需要大量的医院资源。苯二氮䓬类药物是许多重症监护病房治疗 AWS 的一线药物。我们建议使用症状触发型苯巴比妥治疗 AWS，作为苯二氮䓬类药物的安全替代方法。
这是一项回顾性观察研究，纳入了 2011 年至 2015 年期间入住 1 家三级医院 MICU 的所有 AWS 患者，这些患者均接受苯巴比妥治疗。使用症状触发方案。AWS 的缓解情况通过 Richmond 躁动镇静量表评估，目标评分为 0 至-1。Charlson 合并症指数用于评估患者疾病严重程度。分析与苯巴比妥使用和/或 AWS 入院相关的并发症。
共分析了 86 例 AWS 患者的就诊数据。入住 MICU 的 AWS 患者的平均临床戒断评估酒精修订版评分（Clinical Institute Withdrawal Assessment for Alcohol-Revised score）为 19 ± 9。入住 MICU 期间给予的平均苯巴比妥剂量为 1977.5 ± 1531.5mg。共有 17 例（20%）需要插管。AWS 患者需要机械通气的最常见原因是气道清除能力丧失，其次是上消化道出血引起的血流动力学不稳定，以及相应的内镜检查需要。
仅使用苯巴比妥控制 AWS 可能是苯二氮䓬类药物的安全替代方法。需要进一步研究苯巴比妥血清水平与 AWS 临床控制的相关性。
