Safety of Phenobarbital Use for Alcohol Withdrawal Syndrome in the Medical Intensive Care Unit

Abstract

SESSION TITLE: Critical Care Posters I SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: Alcohol withdrawal syndrome (AWS) is a common reason for admission to a medical intensive care unit (MICU) and requires significant hospital resource utilization. Benzodiazepines are a first line therapy for AWS in many intensive care units. We propose that the use of symptom triggered phenobarbital for the treatment of AWS is a safe alternative to benzodiazepines. METHODS: This was a retrospective chart review of a three year period, 2011 to 2014, of all MICU alcohol withdrawal syndrome admissions in whom phenobarbital levels were drawn. Hospital and MICU length of stay, total phenobarbital dose administered, and phenobarbital serum levels were analyzed. Resolution of alcohol withdrawal syndrome was assessed with the Richmond Agitation Sedation Scale (RASS) to goal score of 0 to -1. Severe AWS was defined as a CIWA score greater than 15 prior to MICU assessment and consideration for admission. Complications associated with the AWS admission were recorded. The Charlson Comorbidity Index (CCI) was used as an index of patient illness severity. RESULTS: Data of 40 patients with 45 MICU admissions for AWS was analyzed. The average total phenobarbital dose during the MICU stay was 2131 milligrams. The average CCI was 1.14. The average hospital length of stay was 8.4 days and the average length of MICU stay was 3.89 days. The average phenobarbital serum level was 33.71. There were 4 intubations out of the 45 separate admissions secondary to benzodiazepines administered prior to MICU admission. No patients were intubated secondary to phenobarbital use. One patient was treated for a urinary tract infection; 1 was treated for alcohol associated pancreatitis; 1 was treated for aspiration pneumonia. None of the analyzed patients required an alternative agent for AWS control post MICU stay when phenobarbital was used. CONCLUSIONS: Sole use of phenobarbital use for control of alcohol withdrawal syndrome may be a safe alternative to benzodiazepines. Further study is needed to correlate phenobarbital serum levels and clinical control of AWS. CLINICAL IMPLICATIONS: Phenobarbital may be a suitable substitute in the treatment of severe alcohol withdrawal syndrome necessitating intensive care unit admission. DISCLOSURE: The following authors have nothing to disclose: Krystal Cleven, lauren healy, Mabel Wei, Seth Koenig, Paul Mayo, Mangala Narasimhan, Margarita Oks No Product/Research Disclosure Information