Comparing Length of Stay Between Adult Patients Admitted to the Intensive Care Unit With Alcohol Withdrawal Syndrome Treated with Phenobarbital versus Lorazepam
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Publication Date
2025
Abstract
Introduction: Syphilis has long been known as the great imitator due to its variety of presenting symptoms and organ systems affected. Rationale: Alcohol withdrawal syndrome (AWS) is a common reason for hospital and intensive care unit admissions. Standard of care for treatment of AWS includes use of benzodiazepines (e.g. lorazepam). However, due to the high incidence of AWS in hospitalized patients, and therefore burden on hospital systems, there is interest in identifying more effective treatments. Phenobarbital, a barbiturate, is a safe alternative to benzodiazepines for AWS that has several benefits including its mechanism of action and pharmacokinetics. Methods: We queried the medical record system to review admission data for patients admitted to the ICU for AWS during a 34-month period to determine if there was a difference in length of stay (LOS) between patients who received benzodiazepines versus those who received phenobarbital. Patients were included if they were admitted to the ICU, with a diagnosis of alcohol use disorder, on clinical institute of alcohol withdrawal (CIWA) scoring, who did not have a diagnosis of epilepsy. Simple regression analysis was used to determine associations between LOS and phenobarbital amount, lorazepam amount, and complications (mechanical ventilation). Results: 204 patients were included in the study. 112 patients (52.90%) received phenobarbital and had a mean hospital LOS of 11.82 days (median 8.34 days, SD 9.73) and a mean ICU LOS of 6.91 days, with an average dose of phenobarbital of 11.77 mg/kg. All the patients who received phenobarbital also received lorazepam (average amount 151.08 mg). 87 patients (42.65%) received only lorazepam and had a mean hospital LOS of 10.14 days (median 6.05 days, standard deviation 15.18), mean ICU LOS of 3.39 days, with an average amount of lorazepam of 53.95 mg. There was no significant difference between LOS for patients who received phenobarbital and those who received only lorazepam (p = 0.37). Conclusions: There was no significant difference in LOS between patients who received lorazepam versus those who received phenobarbital for AWS. Additionally, all the patients who were treated with phenobarbital were also treated with lorazepam which increases the risk of respiratory depression (a side effect of both medications). This finding presented an opportunity to develop an initiative to standardize care by establishing a consistent protocol for phenobarbital use in the ICU. We identified severity of withdrawal as a confounder: often patients with the highest CIWA scores received both phenobarbital and lorazepam; suggesting that phenobarbital is safe, but protocols informing its use would improve patient safety and potentially LOS.
Specialty/Research Institute
Graduate Medical Education
