Matecki Mary, Noureldin Ahmed, Akkari Riad, Cohen Zachary, McMullan Matthew, Hawkins Katrina, Williams Jeffrey, Nwude Azuka, Yamane David, Sarani Babak, Lee Sean M, Kartiko Susan
George Washington University, Department of Surgery, Center for Trauma and Critical Care, Washington, DC, USA.
George Washington University, Department of Anesthesiology and Critical Care Medicine, Washington, DC, USA.
J Intensive Care Med. 2025 Sep;40(9):948-955. doi: 10.1177/08850666251328881. Epub 2025 Mar 28.
BackgroundThis study directly compares outcomes of phenobarbital and dexmedetomidine as adjuncts to symptom-triggered benzodiazepine treatment for alcohol withdrawal syndrome (AWS).MethodsThis is a retrospective cohort analysis at a single tertiary referral institution in a major urban center in the United States. In hospitalized patients above 18 years with AWS between May 1, 2018, and July 31, 2021 we compared the hospital length of stay (LOS), ICU LOS, mechanical ventilation incidence and duration of patients who received dexmedetomidine versus phenobarbital as adjuncts to lorazepam-based treatment. Patients were divided into two cohorts based on treatment they received - dexmedetomidine/lorazepam (DEX) versus phenobarbital/lorazepam (PHENO). The use of phenobarbital or dexmedetomidine was left to the discretion of the treating bedside physician.ResultsOne hundred fifty-six patients met inclusion criteria with 102 patients (65%) in the DEX group and 54 patients (35%) in the PHENO group. The PHENO group had a lower probability of intubation (OR 0.33, 95% CI 0.15-0.70, p = 0.005) and shorter hospital LOS (IRR 0.45, 95% CI 0.31-0.64, p < 0.001), and ICU LOS (IRR 0.58, 95% CI 0.34-1.00, p = 0.050). For both hospital and ICU LOS, the PHENO group had shorter LOS than dexmedetomidine at lower doses of lorazepam (<3 mg), but this protective effect diminished at higher doses of lorazepam, at a rate of 10% (hospital LOS, IRR 1.10, 95% CI 1.05-1.16, p < 0.001) and 6% (ICU LOS, IRR 1.06, 95% CI 0.99-1.13, p = 0.074) per milligram increase in lorazepam.ConclusionsA symptom- triggered lorazepam regimen including early phenobarbital administration for severe alcohol withdrawal syndrome is associated with lower hospital LOS and need for intubation compared to a symptom triggered lorazepam regimen with dexmedetomidine adjunct.
背景
本研究直接比较了苯巴比妥和右美托咪定作为酒精戒断综合征（AWS）症状触发型苯二氮䓬类药物治疗辅助药物的疗效。
方法
这是一项在美国一个主要城市中心的单一三级转诊机构进行的回顾性队列分析。在2018年5月1日至2021年7月31日期间患有AWS的18岁以上住院患者中，我们比较了接受右美托咪定与苯巴比妥作为基于劳拉西泮治疗辅助药物的患者的住院时间（LOS）、重症监护病房（ICU）住院时间、机械通气发生率和持续时间。根据患者接受的治疗将其分为两个队列——右美托咪定/劳拉西泮（DEX）组和苯巴比妥/劳拉西泮（PHENO）组。苯巴比妥或右美托咪定的使用由床边治疗医生自行决定。
结果
156名患者符合纳入标准，DEX组有102名患者（65%），PHENO组有54名患者（35%）。PHENO组插管概率较低（比值比[OR]0.33，95%置信区间[CI]0.15 - 0.70，p = 0.005），住院LOS较短（发病率比值比[IRR]0.45，95% CI 0.31 - 0.64，p < 0.001），ICU住院时间也较短（IRR 0.58，95% CI 0.34 - 1.00，p = 0.050）。对于住院和ICU住院时间，在较低剂量劳拉西泮（<3 mg）时，PHENO组的住院时间比右美托咪定组短，但在较高剂量劳拉西泮时，这种保护作用减弱，劳拉西泮每增加1毫克，住院时间的减弱率为10%（住院LOS，IRR 1.10，95% CI 1.05 - 1.16，p < 0.001），ICU住院时间的减弱率为6%（IRR 1.06，95% CI 0.99 - 1.13，p = 0.074）。
结论
与使用右美托咪定作为辅助药物的症状触发型劳拉西泮治疗方案相比，对于严重酒精戒断综合征，一种包括早期使用苯巴比妥的症状触发型劳拉西泮治疗方案与较短的住院时间和较低的插管需求相关。
