From the Department of Pharmaceutical Sciences (L.M.F., W.P.T., L.A.), Department of Pharmaceutical Sciences (J.R.B.), Department of Pharmacy Portfolio in HealthIT (E.W.), Division of Acute Care Surgery (A.J.M., R.T.B., B.M.D., O.D.G., M.C.S.), and Department of Psychiatry and Behavioral Sciences (K.K., D.M.), Vanderbilt University Medical Center, Nashville, Tennessee.
J Trauma Acute Care Surg. 2024 Mar 1;96(3):493-498. doi: 10.1097/TA.0000000000004116. Epub 2023 Aug 21.
Alcohol withdrawal syndrome (AWS) is associated with increased morbidity and mortality in the trauma population. Benzodiazepines (BZDs) are standard of care for AWS; however, given the risk of delirium with BZDs and reports of BZD-refractory withdrawal, phenobarbital (PHB) has emerged as an alternative therapy for AWS. Safety and efficacy studies of PHB for AWS in trauma patients are lacking. Our aim was to compare a BZD versus PHB protocol in the management of AWS in trauma patients.
We performed a retrospective cohort study at a level 1 trauma center of patients at risk for AWS managed with either a BZD or a low-dose oral PHB regimen. Patients were excluded if they were taking BZDs or barbiturates before admission, received propofol or dexmedetomidine before initiation of the study drug, presented with delirium tremens or seizures, or died or discharged within 24 hours of presentation. The primary outcome was complicated AWS (seizures or alcohol withdrawal delirium/delirium tremens). Secondary outcomes included uncomplicated AWS; therapy escalation; oversedation; delirium-, intensive care unit-, and ventilator-free days; and length of stay.
A total of 411 patients were identified; 118 received BZD, and 293 received PHB. The odds of developing complicated AWS with PHB versus BZD-based therapy were not statistically significant (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.21-1.39); however, patients receiving PHB were less likely to develop uncomplicated AWS (OR, 0.08; 95% CI, 0.04-0.14) and less likely to require escalation of therapy (OR, 0.45; 95% CI, 0.24-0.84). The PHB group had a length of stay 3.1 days shorter than the BZD group ( p = 0.002). There was no difference in intensive care unit-, ventilator-, or delirium-free days.
A PHB-based protocol for the management of AWS is a safe and effective alternative to BZD-based regimens in trauma patients.
Therapeutic/Care Management; Level IV.
酒精戒断综合征（AWS）与创伤人群的发病率和死亡率增加有关。苯二氮䓬类药物（BZDs）是 AWS 的标准治疗方法；然而，鉴于 BZDs 引起谵妄的风险以及 BZD 难治性戒断的报告，苯巴比妥（PHB）已成为 AWS 的替代治疗方法。在创伤患者中，关于 PHB 治疗 AWS 的安全性和有效性研究尚缺乏。我们的目的是比较 BZD 与 PHB 方案在创伤患者 AWS 管理中的效果。
我们在一家 1 级创伤中心进行了一项回顾性队列研究，该研究纳入了接受 BZD 或低剂量口服 PHB 方案治疗的有 AWS 风险的患者。如果患者在入院前使用 BZDs 或巴比妥类药物、在开始研究药物前使用丙泊酚或右美托咪定、出现震颤谵妄或癫痫发作、或在就诊后 24 小时内死亡或出院，则将其排除在外。主要结局是复杂 AWS（癫痫发作或酒精戒断性谵妄/震颤谵妄）。次要结局包括非复杂 AWS；治疗升级；过度镇静；谵妄、重症监护病房和呼吸机无使用天数；以及住院时间。
共确定了 411 名患者；118 名患者接受了 BZD 治疗，293 名患者接受了 PHB 治疗。与 BZD 治疗相比，接受 PHB 治疗的患者发生复杂 AWS 的几率无统计学意义（比值比 [OR]，0.52；95%置信区间 [CI]，0.21-1.39）；然而，接受 PHB 治疗的患者发生非复杂 AWS 的几率较低（OR，0.08；95% CI，0.04-0.14），且需要升级治疗的几率较低（OR，0.45；95% CI，0.24-0.84）。PHB 组的住院时间比 BZD 组短 3.1 天（p=0.002）。两组在重症监护病房、呼吸机和谵妄无使用天数方面无差异。
与 BZD 方案相比，PHB 方案是创伤患者 AWS 管理的一种安全有效的替代方案。
治疗/护理管理；IV 级。
