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Evaluation of Effectiveness of Phenobarbital in Treatment of Alcohol Withdrawal Syndrome in a Medical Intensive Care Unit FREE TO VIEW

Harman Kular; Philip Alapat
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Baylor College of Medicine, Houston, TX

Chest. 2014;146(4_MeetingAbstracts):226A. doi:10.1378/chest.1993653
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SESSION TITLE: Non Pulmonary Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: To compare the outcomes of all patients with alcohol withdrawal syndrome admitted to the medical intensive care unit of an inner city county hospital (Ben Taub General Hospital in Houston, TX) treated with benzodiazepines versus those who received phenobarbital in addition to benzodiazepines.

METHODS: Retrospective chart review of all patients admitted to the MICU with a principle diagnosis of alcohol withdrawal syndrome from 8/2009-7/2011. Patients were split into two groups based on treatment received in the MICU- benzodiazepines only or benzodiazepines and phenobarbital. Multiple characteristics of the patients and their course were recorded and analyzed, including length of admission, need for mechanical ventilation, length of intubation and occurence of pneumonia.

RESULTS: The study identified 38 patients who met inclusion criteria. Of these patients, 20 received only benzodiazepines (BZD group) and 18 received benzodiazepines and phenobarbital (PB group). The length of total hospital days in the BZD group was longer than the PB group (14.5 vs. 12.5, p=0.28). MICU length of stay was longer in the BZD group (7.60 vs. 7.28, p=0.43). Length of intubation was longer in the BZD group (6.92 vs. 6.25, p=0.346). As the reported p values indicate, the differences were not statistically significant. The occurrence of intubation was 60% vs. 44% in the BZD and PB groups respectively. The incidence of pneumonia was 30% vs. 16.7% in the BZD and PB group respectively.

CONCLUSIONS: Patients in both treatment groups did not have statistically significant different outcomes. The sample size of 38 patients was over a time period of 23 months, the study would have benefited from a larger sample size over a longer time period. The data does indicate that phenobarbital use did not result in significantly negative outcomes in our population of intensive care patients. Thus, the use of phenobarbital for the treatment of alcohol withdrawal syndrome warrants further investigation.

CLINICAL IMPLICATIONS: Alcohol withdrawal continues to be a common and serious condition in patients admitted to medical intensive care units. Current standard of care is tapering doses of benzodiazepines only. Phenobarbital is a readily available medication that has been shown to have effectiveness in the treatment of acute alcohol withdrawal in the emergency room setting but its use in the MICU has yet to be investigated fully. Evidence supporting phenobarbital use in the MICU should provide support for the creation of potential prospective studies.

DISCLOSURE: The following authors have nothing to disclose: Harman Kular, Philip Alapat

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