Deveau Robert, Wong Adrian, Eche Mary, Yankama Tuyen, Fehnel Corey R
Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA.
Ann Pharmacother. 2025 Mar;59(3):205-212. doi: 10.1177/10600280241271156. Epub 2024 Aug 20.
Alcohol withdrawal syndrome (AWS) is a complication of alcohol use disorder that manifests as a range of symptoms. Symptom-triggered benzodiazepines (BZDs) are often used as first-line treatment of AWS. However, recent literature suggests phenobarbital (PHB) may be safer and more efficacious, but studies are limited by exclusion of patients with neurological injuries.
We aimed to evaluate the safety of PHB compared to BZDs for the management of AWS among patients with primary neurologic injuries.
Retrospective cohort study of patients with primary neurologic injuries admitted to an ICU who received PHB or symptom-triggered BZD for AWS between December 2013 and February 2020. The primary outcome was incidence of oversedation, defined as Richmond Agitation Sedation Scale (RASS) scores from -5 to -3 within 24 hours of initial PHB or BZD dose. Secondary outcomes included largest decrease in RASS, need for mechanical ventilation, and additional sedative use within 24 hours of initial PHB or BZD dose. A multivariable analysis was performed to evaluate the association of PHB administration with the primary outcome.
Among 600 patients treated for AWS, 84 patients were included in our analysis (PHB, n = 56; BZD, n = 28). In the unadjusted analysis, there were no differences between the PHB and BZD groups for the primary outcome of oversedation (21.4 vs. 7.1%, = 0.13), or secondary outcomes of decrease in RASS ( = 0.34), or new ventilator requirement ( = 0.55). Patients who received PHB had higher rates of additional sedative use ( < 0.01). Multivariable regression revealed an increase in oversedation among intubated patients ( = 0.014), while PHB administration was not independently associated with oversedation ( = 0.516).
Phenobarbital did not independently increase the risk of oversedation compared to BZD for AWS in patients with primary neurologic injuries. Future studies should determine optimal dosing of PHB in this population.
酒精戒断综合征（AWS）是酒精使用障碍的一种并发症，表现为一系列症状。症状触发的苯二氮䓬类药物（BZDs）常被用作AWS的一线治疗药物。然而，最近的文献表明苯巴比妥（PHB）可能更安全、更有效，但研究因排除了神经损伤患者而受到限制。
我们旨在评估在原发性神经损伤患者中，与BZDs相比，PHB用于管理AWS的安全性。
对2013年12月至2020年2月期间入住重症监护病房（ICU）并因AWS接受PHB或症状触发的BZD治疗的原发性神经损伤患者进行回顾性队列研究。主要结局是过度镇静的发生率，定义为在首次给予PHB或BZD剂量后24小时内Richmond躁动镇静量表（RASS）评分为-5至-3。次要结局包括RASS最大降幅、机械通气需求以及在首次给予PHB或BZD剂量后24小时内额外使用镇静剂的情况。进行多变量分析以评估PHB给药与主要结局之间的关联。
在600例接受AWS治疗的患者中，84例纳入我们的分析（PHB组，n = 56；BZD组，n = 28）。在未调整分析中，PHB组和BZD组在过度镇静的主要结局方面（21.4%对7.1%，P = 0.13）、RASS降幅的次要结局方面（P = 0.34）或新的通气需求方面（P = 0.55）均无差异。接受PHB治疗的患者额外使用镇静剂的比例更高（P < 0.01）。多变量回归显示插管患者过度镇静增加（P = 0.014），而PHB给药与过度镇静无独立关联（P = 0.516）。
对于原发性神经损伤患者，与BZD相比，PHB不会独立增加AWS患者过度镇静的风险。未来研究应确定该人群中PHB的最佳剂量。
