Department of Pharmacy, Advocate Christ Medical Center, 4440 West 95th Street, Oak Lawn, IL, 60453, USA.
Department of Pharmacy, HSHS St. John's Hospital, Springfield, IL, USA.
J Med Toxicol. 2022 Jul;18(3):198-204. doi: 10.1007/s13181-022-00900-8. Epub 2022 Jun 6.
Phenobarbital is frequently used to manage severe alcohol withdrawal. The purpose of this study was to compare the incidence of mechanical ventilation in patients with benzodiazepine-resistant alcohol withdrawal between front-loaded and low-intermittent phenobarbital dosing strategies.
In this retrospective before-after study, we analyzed patients that received phenobarbital for severe alcohol withdrawal syndrome in a tertiary medical ICU. Patients received low-intermittent phenobarbital doses (260 mg intravenous push × 1 followed by 130 mg intravenous push every 15 min as needed) from January 2013 to July 2015, and front-loaded phenobarbital doses (10 mg/kg intravenous infusion over 30 min) from July 2015 to January 2017.
In total, 87 patients met inclusion criteria for this study: 41 received low-intermittent phenobarbital and 46 received front-loaded phenobarbital). The incidence of mechanical ventilation was 13 (28%) in the front-loaded dosing group vs. 26 (63%) in the low-intermittent dosing group (odds ratio 4.4 [95% CI 1.8-10.9]). The cumulative dose of phenobarbital administered and serum phenobarbital levels were similar between both groups, although the front-loaded group had significantly lower benzodiazepine requirements than the low-intermittent group (median 86 mg [IQR 24-197] vs. 228 mg [115-298], P < 0.01) and reduced need for any continuous sedative infusion (OR 7.7 [95% CI 1.6-27], P < 0.01). There was no difference in respiratory failure or hypotension.
Front-loaded phenobarbital dosing, when compared to low-intermittent phenobarbital dosing, for benzodiazepine-resistant alcohol withdrawal was associated with significantly lower mechanical ventilation incidence and continuous sedative use.
苯巴比妥常用于治疗严重的酒精戒断。本研究的目的是比较负荷剂量与低剂量间断输注苯巴比妥治疗苯二氮䓬类药物抵抗性酒精戒断患者机械通气发生率的差异。
本回顾性前后对照研究分析了在一家三级医疗 ICU 接受苯巴比妥治疗严重酒精戒断综合征的患者。患者在 2013 年 1 月至 2015 年 7 月期间接受低剂量间断输注苯巴比妥（1 次静脉推注 260mg，必要时每 15 分钟静脉推注 130mg），在 2015 年 7 月至 2017 年 1 月期间接受负荷剂量苯巴比妥（10mg/kg 静脉输注 30 分钟）。
共有 87 例患者符合本研究纳入标准：41 例接受低剂量间断输注苯巴比妥，46 例接受负荷剂量苯巴比妥。负荷剂量组机械通气发生率为 13（28%），低剂量间断输注组为 26（63%）（比值比 4.4 [95%CI 1.8-10.9]）。两组患者的苯巴比妥累积剂量和血清苯巴比妥水平相似，尽管负荷剂量组的苯二氮䓬类药物需求明显低于低剂量间断输注组（中位数 86mg [IQR 24-197] vs. 228mg [115-298]，P<0.01），且需要任何连续镇静输注的比例也更低（比值比 7.7 [95%CI 1.6-27]，P<0.01）。两组患者呼吸衰竭或低血压发生率无差异。
与低剂量间断输注苯巴比妥相比，负荷剂量苯巴比妥治疗苯二氮䓬类药物抵抗性酒精戒断患者机械通气发生率和连续镇静使用率显著降低。
