建立苯巴比妥治疗普通病房酒精戒断综合征的安全性:一项回顾性队列研究。

IF 2.5 4区 医学 Q3 PHARMACOLOGY & PHARMACY
Matthew V. Ronan , Rahul B. Ganatra , Jussi Saukkonen
{"title":"建立苯巴比妥治疗普通病房酒精戒断综合征的安全性:一项回顾性队列研究。","authors":"Matthew V. Ronan ,&nbsp;Rahul B. Ganatra ,&nbsp;Jussi Saukkonen","doi":"10.1016/j.alcohol.2023.10.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Concern about adverse effects from phenobarbital limits its use in treating alcohol withdrawal syndrome (AWS) on general medical wards. Benzodiazepines are the recommended treatment for inpatient management of AWS, yet a subset of patients have an inadequate response or experience complications of AWS despite treatment with benzodiazepines. Data supporting an alternative treatment are needed. We set out to estimate the rate of serious adverse events (SAEs) of phenobarbital treatment for AWS on general medical wards.</p></div><div><h3>Methods</h3><p>Retrospective cohort study of all general medical ward patients hospitalized at a single tertiary urban VA Medical Center from October 2018–May 2021 who received phenobarbital for treatment of AWS. Primary outcomes were SAEs attributed to phenobarbital and treatment failure. SAEs were defined as ICU transfer or intubation for over-sedation, pneumonia, and death. Treatment failure was defined as progression of withdrawal resulting in seizure, ICU transfer, behavioral emergencies, or death.</p></div><div><h3>Results</h3><p>During the study period, phenobarbital was administered in 29% (244) of all AWS hospitalizations. Among them, 93% had a history of AWS hospitalization and 68% had a history of complicated AWS. Fifty-three percent of patients met criteria for moderate, severe, or complicated withdrawal prior to phenobarbital initiation. The mean cumulative dose of phenobarbital per patient was 966.5 mg (13.6 mg/kg). SAEs occurred in 1 of 244 hospitalizations (0.4%): there were no intubations, ICU transfers for oversedation, or deaths due to phenobarbital or AWS. One case of pneumonia was possibly attributable to phenobarbital. Treatment failures (6 ICU transfers, 9 behavioral emergencies) were identified during 12 of 244 hospitalizations (4.9%).</p></div><div><h3>Conclusions</h3><p>SAEs and treatment failures were infrequent among 148 patients treated with phenobarbital across 244 hospitalizations with a mean cumulative dose of 966.5 mg per patient. Our findings suggest that phenobarbital is a safe alternative treatment of AWS in general medical ward patients.</p></div>","PeriodicalId":7712,"journal":{"name":"Alcohol","volume":"116 ","pages":"Pages 29-34"},"PeriodicalIF":2.5000,"publicationDate":"2023-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Establishing the safety of phenobarbital treatment of alcohol withdrawal syndrome on general medical wards: A retrospective cohort study\",\"authors\":\"Matthew V. Ronan ,&nbsp;Rahul B. Ganatra ,&nbsp;Jussi Saukkonen\",\"doi\":\"10.1016/j.alcohol.2023.10.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>Concern about adverse effects from phenobarbital limits its use in treating alcohol withdrawal syndrome (AWS) on general medical wards. Benzodiazepines are the recommended treatment for inpatient management of AWS, yet a subset of patients have an inadequate response or experience complications of AWS despite treatment with benzodiazepines. Data supporting an alternative treatment are needed. We set out to estimate the rate of serious adverse events (SAEs) of phenobarbital treatment for AWS on general medical wards.</p></div><div><h3>Methods</h3><p>Retrospective cohort study of all general medical ward patients hospitalized at a single tertiary urban VA Medical Center from October 2018–May 2021 who received phenobarbital for treatment of AWS. Primary outcomes were SAEs attributed to phenobarbital and treatment failure. SAEs were defined as ICU transfer or intubation for over-sedation, pneumonia, and death. Treatment failure was defined as progression of withdrawal resulting in seizure, ICU transfer, behavioral emergencies, or death.</p></div><div><h3>Results</h3><p>During the study period, phenobarbital was administered in 29% (244) of all AWS hospitalizations. Among them, 93% had a history of AWS hospitalization and 68% had a history of complicated AWS. Fifty-three percent of patients met criteria for moderate, severe, or complicated withdrawal prior to phenobarbital initiation. The mean cumulative dose of phenobarbital per patient was 966.5 mg (13.6 mg/kg). SAEs occurred in 1 of 244 hospitalizations (0.4%): there were no intubations, ICU transfers for oversedation, or deaths due to phenobarbital or AWS. One case of pneumonia was possibly attributable to phenobarbital. Treatment failures (6 ICU transfers, 9 behavioral emergencies) were identified during 12 of 244 hospitalizations (4.9%).</p></div><div><h3>Conclusions</h3><p>SAEs and treatment failures were infrequent among 148 patients treated with phenobarbital across 244 hospitalizations with a mean cumulative dose of 966.5 mg per patient. Our findings suggest that phenobarbital is a safe alternative treatment of AWS in general medical ward patients.</p></div>\",\"PeriodicalId\":7712,\"journal\":{\"name\":\"Alcohol\",\"volume\":\"116 \",\"pages\":\"Pages 29-34\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2023-11-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Alcohol\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0741832923002859\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Alcohol","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0741832923002859","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0

摘要

简介:对苯巴比妥不良反应的担忧限制了其在普通病房治疗酒精戒断综合征(AWS)中的应用。苯二氮卓类药物是住院治疗AWS的推荐治疗方法,然而,尽管使用苯二氮卓类药物治疗,仍有一部分患者对AWS反应不足或出现并发症。需要支持替代治疗的数据。我们着手估计在普通病房接受苯巴比妥治疗的AWS患者严重不良事件(SAEs)的发生率。方法:回顾性队列研究2018年10月至2021年5月在单一三级城市VA医疗中心住院的所有普通病房患者,这些患者接受了苯巴比妥治疗AWS。主要结局是由苯巴比妥和治疗失败引起的急性脑梗死。sae被定义为因过度镇静、肺炎和死亡而转入ICU或插管。治疗失败的定义为停药进展导致癫痫发作、转入ICU、行为紧急或死亡。结果:在研究期间,29%(244)的AWS住院患者使用了苯巴比妥。其中93%有AWS住院史,68%有复杂AWS病史。53%的患者在苯巴比妥开始治疗前符合中度、重度或复杂戒断标准。每位患者苯巴比妥的平均累积剂量为966.5mg (13.6 mg/kg)。244例住院患者中有1例(0.4%)发生了急性呼吸窘迫事件:没有插管,没有因过度镇静而转移到ICU,也没有因苯巴比妥或AWS导致的死亡。1例肺炎可能归因于苯巴比妥。244例住院患者中有12例(4.9%)出现治疗失败(6例转至ICU, 9例行为紧急情况)。结论:在244例平均累积剂量为966.5mg /例的148例接受苯巴比妥治疗的住院患者中,SAEs和治疗失败罕见。我们的研究结果表明,苯巴比妥是普通病房患者的一种安全的替代治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Establishing the safety of phenobarbital treatment of alcohol withdrawal syndrome on general medical wards: A retrospective cohort study

Introduction

Concern about adverse effects from phenobarbital limits its use in treating alcohol withdrawal syndrome (AWS) on general medical wards. Benzodiazepines are the recommended treatment for inpatient management of AWS, yet a subset of patients have an inadequate response or experience complications of AWS despite treatment with benzodiazepines. Data supporting an alternative treatment are needed. We set out to estimate the rate of serious adverse events (SAEs) of phenobarbital treatment for AWS on general medical wards.

Methods

Retrospective cohort study of all general medical ward patients hospitalized at a single tertiary urban VA Medical Center from October 2018–May 2021 who received phenobarbital for treatment of AWS. Primary outcomes were SAEs attributed to phenobarbital and treatment failure. SAEs were defined as ICU transfer or intubation for over-sedation, pneumonia, and death. Treatment failure was defined as progression of withdrawal resulting in seizure, ICU transfer, behavioral emergencies, or death.

Results

During the study period, phenobarbital was administered in 29% (244) of all AWS hospitalizations. Among them, 93% had a history of AWS hospitalization and 68% had a history of complicated AWS. Fifty-three percent of patients met criteria for moderate, severe, or complicated withdrawal prior to phenobarbital initiation. The mean cumulative dose of phenobarbital per patient was 966.5 mg (13.6 mg/kg). SAEs occurred in 1 of 244 hospitalizations (0.4%): there were no intubations, ICU transfers for oversedation, or deaths due to phenobarbital or AWS. One case of pneumonia was possibly attributable to phenobarbital. Treatment failures (6 ICU transfers, 9 behavioral emergencies) were identified during 12 of 244 hospitalizations (4.9%).

Conclusions

SAEs and treatment failures were infrequent among 148 patients treated with phenobarbital across 244 hospitalizations with a mean cumulative dose of 966.5 mg per patient. Our findings suggest that phenobarbital is a safe alternative treatment of AWS in general medical ward patients.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Alcohol
Alcohol 医学-毒理学
CiteScore
4.60
自引率
4.30%
发文量
74
审稿时长
15.6 weeks
期刊介绍: Alcohol is an international, peer-reviewed journal that is devoted to publishing multi-disciplinary biomedical research on all aspects of the actions or effects of alcohol on the nervous system or on other organ systems. Emphasis is given to studies into the causes and consequences of alcohol abuse and alcoholism, and biomedical aspects of diagnosis, etiology, treatment or prevention of alcohol-related health effects. Intended for both research scientists and practicing clinicians, the journal publishes original research on the neurobiological, neurobehavioral, and pathophysiological processes associated with alcohol drinking, alcohol abuse, alcohol-seeking behavior, tolerance, dependence, withdrawal, protracted abstinence, and relapse. In addition, the journal reports studies on the effects alcohol on brain mechanisms of neuroplasticity over the life span, biological factors associated with adolescent alcohol abuse, pharmacotherapeutic strategies in the treatment of alcoholism, biological and biochemical markers of alcohol abuse and alcoholism, pathological effects of uncontrolled drinking, biomedical and molecular factors in the effects on liver, immune system, and other organ systems, and biomedical aspects of fetal alcohol spectrum disorder including mechanisms of damage, diagnosis and early detection, treatment, and prevention. Articles are published from all levels of biomedical inquiry, including the following: molecular and cellular studies of alcohol''s actions in vitro and in vivo; animal model studies of genetic, pharmacological, behavioral, developmental or pathophysiological aspects of alcohol; human studies of genetic, behavioral, cognitive, neuroimaging, or pathological aspects of alcohol drinking; clinical studies of diagnosis (including dual diagnosis), treatment, prevention, and epidemiology. The journal will publish 9 issues per year; the accepted abbreviation for Alcohol for bibliographic citation is Alcohol.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信