William P. Tidwell is a clinical pharmacist, Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee. Tonya L. Thomas is a clinical pharmacist, Department of Pharmacy, Saint Thomas West Hospital, Nashville, Tennessee. Angus J. Webber is a hospitalist, Saint Thomas West Hospital, Nashville. Jonathon D. Pouliot is an assistant professor, College of Pharmacy and Health Sciences, Lipscomb University, Nashville, Tennessee, and a clinical pharmacist, Department of Pharmacy, Saint Thomas West Hospital, Nashville. Angelo E. Canonico is an associate professor, College of Medicine, University of Tennessee Health Sciences Center, Nashville, and a pulmonologist intensivist, Saint Thomas Medical Group, Nashville.
Am J Crit Care. 2018 Nov;27(6):454-460. doi: 10.4037/ajcc2018745.
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.
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.
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.
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; < .001). Those who received phenobarbital also had significantly shorter hospital stays (4.3 [3.4] vs 6.9 [6.6] days; = .004). The incidence of invasive mechanical ventilation was lower in the phenobarbital group (1 [2%] vs 14 [23%] patients; < .001), as was use of adjunctive agents for symptom control, including dexmedetomidine (4 [7%] vs 17 [28%] patients; = .002).
A phenobarbital protocol for the treatment of alcohol withdrawal is an effective alternative to the standard-of-care protocol of symptom-triggered benzodiazepine therapy.
苯二氮䓬类药物治疗酒精戒断会引起激越和呼吸抑制。治疗可能会因需要辅助治疗来控制这些症状而变得复杂，对于需要机械通气的患者更是如此。尽管有苯巴比妥等有前途的药物，但缺乏替代治疗方法有效性的有力证据。
比较酒精戒断的标准治疗方法——一种与修订后的酒精戒断临床研究所评估量表（CIWA-Ar）联合使用的症状触发苯二氮䓬类药物方案——与苯巴比妥方案。
这是一项回顾性队列研究，于 2016 年 1 月至 2017 年 6 月在田纳西州纳什维尔的一家私人教学医院的 42 张病床的重症监护病房进行。主要结局是重症监护病房的住院时间。次要结局包括住院时间、有创机械通气的发生率以及辅助药物治疗的使用。
接受苯巴比妥治疗的患者在重症监护病房的停留时间明显短于接受 CIWA-Ar 量表治疗的患者（平均[标准差]，2.4[1.5]天 vs 4.4[3.9]天；<0.001）。接受苯巴比妥治疗的患者住院时间也明显缩短（4.3[3.4]天 vs 6.9[6.6]天；=0.004）。苯巴比妥组的有创机械通气发生率较低（1[2%]例 vs 14[23%]例；<0.001），用于控制症状的辅助药物的使用也较低，包括右美托咪定（4[7%]例 vs 17[28%]例；=0.002）。
苯巴比妥治疗酒精戒断的方案是治疗酒精戒断的标准方案——症状触发苯二氮䓬类药物治疗的有效替代方案。
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