From the Acute Care Pharmacy Services (L.M.K.), UK HealthCare, Lexington, Kentucky; Department of Pharmacy (L.M.K., A.F., I.L.) and Division of Trauma Surgery and Surgical Critical Care, Department of Surgery (J.D.D.), UMass Memorial Medical Center, Worcester, Massachusetts.
J Trauma Acute Care Surg. 2023 Oct 1;95(4):573-576. doi: 10.1097/TA.0000000000004039. Epub 2023 Jun 15.
Up to 30% of trauma patients experience alcohol withdrawal syndrome (AWS) during their hospital admission, which is associated with worse outcomes. While benzodiazepines and phenobarbital are the mainstay of AWS management, there are limited data on the prevention of AWS. The objective was to evaluate the safety and efficacy of phenobarbital for the prevention of AWS.
Adult patients admitted to a level 1 trauma center who received at least one dose of phenobarbital for the prevention of AWS between January 2019 and August 2021 were included. Patients were case matched to a control group managed with symptom-triggered therapy based on risk of AWS. Risk factors included sex, age, history of AWS/delirium tremens or withdrawal seizures, selected laboratory values, and screening questionnaires. The primary endpoint was the need for rescue therapy. Secondary endpoints included the time to rescue therapy, intensive care unit (ICU) length of stay (LOS), and hospital LOS.
Overall, 110 patients were included with 55 patients in each group. The phenobarbital group had higher baseline Injury Severity Scores ( p = 0.03) and were more likely to be admitted to the ICU (44% vs. 24%; p = 0.03). The phenobarbital group required less rescue therapy (16% vs. 62%; p < 0.001) with a longer time to rescue therapy administration (26 vs. 11 hours; p = 0.01). The phenobarbital group had a longer hospital LOS (216 vs. 87 hours; p = 0.0001) but no difference in ICU LOS ( p = 0.36). There was no incidence of delirium tremens or seizures and no difference in intubation rates ( p = 0.68). There was no incidence of hypotension associated with phenobarbital.
Patients managed with phenobarbital had a lower need for rescue therapy for AWS with no increased adverse effects. Further studies should evaluate a protocol to prevent alcohol withdrawal in the trauma population.
Therapeutic/Care Management; Level III.
多达 30%的创伤患者在住院期间会出现酒精戒断综合征（AWS），这与更差的结局相关。虽然苯二氮䓬类药物和苯巴比妥是 AWS 管理的主要方法，但预防 AWS 的数据有限。目的是评估苯巴比妥预防 AWS 的安全性和有效性。
纳入 2019 年 1 月至 2021 年 8 月期间在一级创伤中心接受至少一剂苯巴比妥预防 AWS 的成年患者。根据 AWS 风险，患者与接受症状触发治疗的对照组进行病例匹配。风险因素包括性别、年龄、AWS/震颤谵妄或戒断性癫痫发作史、选定的实验室值和筛查问卷。主要终点是需要挽救性治疗。次要终点包括挽救性治疗的时间、重症监护病房（ICU）住院时间（LOS）和住院 LOS。
总体而言，共纳入 110 例患者，每组 55 例。苯巴比妥组基线损伤严重程度评分较高（p=0.03），更有可能入住 ICU（44%比 24%；p=0.03）。苯巴比妥组需要的挽救性治疗较少（16%比 62%；p<0.001），挽救性治疗给药时间较长（26 比 11 小时；p=0.01）。苯巴比妥组住院时间较长（216 比 87 小时；p=0.0001），但 ICU 住院时间无差异（p=0.36）。没有震颤谵妄或癫痫发作的发生率，气管插管率也没有差异（p=0.68）。苯巴比妥没有低血压的相关不良反应。
接受苯巴比妥治疗的患者 AWS 挽救性治疗需求较低，且没有增加不良反应。进一步的研究应该评估预防创伤人群酒精戒断的方案。
治疗/护理管理；III 级。
