Phenobarbital Versus Benzodiazepines for the Treatment of Severe Alcohol Withdrawal.

IF 2.3 4区 医学 Q3 PHARMACOLOGY & PHARMACY
Annals of Pharmacotherapy Pub Date : 2024-09-01 Epub Date: 2024-01-21 DOI:10.1177/10600280231221241
Katherine M Kessel, Logan M Olson, Derek A Kruse, Elizabeth R Lyden, Kelsey E Whiston, Mindy M Blodgett, Alena A Balasanova
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引用次数: 0

Abstract

Background: Phenobarbital may offer advantages over benzodiazepines for severe alcohol withdrawal syndrome (SAWS), but its impact on clinical outcomes has not been fully elucidated.

Objective: The purpose of this study was to determine the clinical impact of phenobarbital versus benzodiazepines for SAWS.

Methods: This retrospective cohort study compared phenobarbital to benzodiazepines for the management of SAWS for patients admitted to progressive or intensive care units (ICUs) between July 2018 and July 2022. Patients included had a history of delirium tremens (DT) or seizures, Clinical Institute Withdrawal Assessment of Alcohol-Revised (CIWA-Ar) >15, or Prediction of Alcohol Withdrawal Severity Scale (PAWSS) score ≥4. The primary outcome was hospital length of stay (LOS). Secondary outcomes included progressive or ICU LOS, incidence of adjunctive pharmacotherapy, and incidence/duration of mechanical ventilation.

Results: The final analysis included 126 phenobarbital and 98 benzodiazepine encounters. Patients treated with phenobarbital had shorter median hospital LOS versus those treated with benzodiazepines (2.8 vs 4.7 days; P < 0.0001); a finding corroborated by multivariable analysis. The phenobarbital group also had shorter median progressive/ICU LOS (0.7 vs 1.3 days; P < 0.0001), and lower incidence of dexmedetomidine (P < 0.0001) and antipsychotic initiation (P < 0.0001). Fewer patients in the phenobarbital group compared to the benzodiazepine group received new mechanical ventilation (P = 0.045), but median duration was similar (1.2 vs 1.6 days; P = 1.00).

Conclusion and relevance: Scheduled phenobarbital was associated with decreased hospital LOS compared to benzodiazepines for SAWS. This was the first study to compare outcomes of fixed-dose, nonoverlapping phenobarbital to benzodiazepines in patients with clearly defined SAWS and details a readily implementable protocol.

苯巴比妥与苯并二氮杂卓在治疗严重酒精戒断方面的对比。
背景:苯巴比妥在治疗严重酒精戒断综合征(SAWS)方面可能比苯二氮卓类药物更具优势,但其对临床结果的影响尚未完全阐明:在治疗严重酒精戒断综合征(SAWS)时,苯巴比妥可能比苯二氮卓类药物更具优势,但其对临床结果的影响尚未完全阐明:本研究旨在确定苯巴比妥与苯二氮卓类药物对严重酒精戒断综合征的临床影响:这项回顾性队列研究比较了苯巴比妥和苯二氮卓类药物对2018年7月至2022年7月期间入住进展期或重症监护病房(ICU)的SAWS患者的治疗效果。纳入的患者均有震颤性谵妄(DT)或癫痫发作病史,临床研究所酒精戒断评估修订版(CIWA-Ar)>15,或酒精戒断严重程度预测量表(PAWSS)评分≥4。主要结果是住院时间(LOS)。次要结果包括进展期或 ICU LOS、辅助药物治疗的发生率以及机械通气的发生率/持续时间:最终分析包括 126 次苯巴比妥治疗和 98 次苯二氮卓治疗。苯巴比妥类药物治疗患者的中位住院时间比苯二氮卓类药物治疗患者的中位住院时间短(2.8 天 vs 4.7 天;P < 0.0001);多变量分析证实了这一结果。苯巴比妥组的进展期/重症监护室中位住院日也更短(0.7 天 vs 1.3 天;P < 0.0001),右美托咪定(P < 0.0001)和抗精神病药物的使用率也更低(P < 0.0001)。苯巴比妥组接受新机械通气的患者少于苯二氮卓组(P = 0.045),但中位持续时间相似(1.2 vs 1.6 天;P = 1.00):与苯二氮卓类药物相比,苯巴比妥类药物可缩短SAWS的住院时间。这是第一项比较固定剂量、不重叠的苯巴比妥与苯二氮卓类药物对明确定义的 SAWS 患者治疗效果的研究,并详细介绍了一种易于实施的方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.70
自引率
0.00%
发文量
166
审稿时长
3-8 weeks
期刊介绍: Annals of Pharmacotherapy (AOP) is a peer-reviewed journal that advances pharmacotherapy throughout the world by publishing high-quality research and review articles to achieve the most desired health outcomes.The articles provide cutting-edge information about the most efficient, safe and cost-effective pharmacotherapy for the treatment and prevention of various illnesses. This journal is a member of the Committee on Publication Ethics (COPE). Average time from submission to first decision: 14 days
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