1126

Abstract

Introduction: Benzodiazepines (BZD) are initially used for treatment of alcohol withdrawal. Phenobarbital (PB) is a barbiturate agent that has also been used in managing alcohol withdrawal symptoms, especially refractory to BZD. However, limited data is available in critically ill patients. The purpose of our study is to describe our institution’s experience with adjunctive PB use in managing severe alcohol withdrawal in the intensive care unit (ICU). Hypothesis: PB can be safely used adjunctively with BZD in managing severe alcohol withdrawal symptoms in the ICU. Methods: A retrospective review was performed for patients who received PB for severe alcohol withdrawal admitted to the medical ICU from July 2011 to February 2012. Patients were managed with the medical ICU severe alcohol withdrawal protocol which utilizes a step-wise approach with BZD and PB. IRB approval was granted. Data were collected on demographics, time to symptom control, medication doses, ventilator days, ICU length of stay and adverse effects of PB. Results: Of the 28 patients analyzed, the mean values for medication requirements were as follows: average amount of PB administered = 1086 mg + 390 mg, cumulative dose of lorazepam administered in the first 24 hours of protocol initiation = 209 mg + 145 mg and duration of continuous sedative infusions = 97 + 59.8 hours. The average time to symptom control was 1.4 + 0.7 hours. The majority of patients (18/28) requiring mechanical ventilation were for reasons unrelated to PB. Average duration of mechanical ventilation was 5.7 + 2.1 days and average ICU length of stay was 7.9 + 2.4 days. Complications of PB included respiratory failure requiring intubation in 2/28 (7.1%) and hypotension in 3/28 (10.7%) of the study population. Conclusions: PB when used adjunctively with BZD was able to control severe alcohol withdrawal symptoms in the ICU with minimal complications. PB may have a potential role for managing severe alcohol withdrawal symptoms in critically ill patients that are not adequately controlled with BZD. Continued work is directed at comparing outcomes before and after PB use in the medical ICU.