与劳拉西泮症状触发疗法相比,苯巴比妥分量和减量疗法对住院患者的影响。

IF 2.3 4区 医学 Q3 PHARMACOLOGY & PHARMACY
Annals of Pharmacotherapy Pub Date : 2024-09-01 Epub Date: 2024-01-23 DOI:10.1177/10600280231222294
Alyson M Esteves, Matthew C Buchfellner, Brooke M Holmes, Joseph A Berndsen, Matthew A Roginski
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引用次数: 0

摘要

背景:苯二氮卓类药物是治疗酒精戒断的首选药物。苯巴比妥是一种替代药物,适用于有专业处方或苯二氮卓禁忌症的患者:评估苯巴比妥剂量策略的有效性和安全性,该策略旨在治疗不同患者群体的各种酒精戒断症状:回顾性分析2018年5月至2022年11月期间因酒精戒断而入院的患者。患者被分为使用劳拉西泮或苯巴比妥的前后队列。主要结果是住院时间(LOS)。次要结果是重症监护室(ICU)的住院时间、呼吸支持的升级、护理级别(LOC)的提高以及震颤性谵妄和/或癫痫发作的发生率:结果:277 名患者接受了劳拉西泮治疗,198 名患者接受了苯巴比妥治疗。苯巴比妥组的住院时间长于劳拉西泮组(6.9 天 vs 9.3 天)。重症监护室的住院时间没有差异。苯巴比妥组别中护理级别提高的情况较少(4 例与 19 例)。劳拉西泮组的无创呼吸干预率较高,而苯巴比妥组的机械通气率较高。使用苯巴比妥可减少震颤性谵妄和癫痫发作:本研究的新颖之处在于,苯巴比妥医嘱集广泛应用于多个护理级别和患者入院诊断。以风险为目标的分负荷静脉注射苯巴比妥医嘱组可以安全地对患者用药,减少护理升级、癫痫发作、震颤性谵妄和呼吸护理升级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of a Divided Phenobarbital Load and Taper Compared With Lorazepam Symptom Triggered Therapy in Hospitalized Patients.

Background: Benzodiazepines are the preferred treatment for alcohol withdrawal. Phenobarbital is an alternative in the setting of prescriber expertise or benzodiazepine contraindication.

Objective: To evaluate the efficacy and safety of a phenobarbital dosing strategy aimed at treating a spectrum of alcohol withdrawal symptoms across various patient populations.

Methods: Retrospective review of patients admitted with concerns of alcohol withdrawal between May 2018 and November 2022. Patients were separated into a before-after cohort of lorazepam or phenobarbital. The primary outcome was hospital length of stay (LOS). Secondary outcomes were intensive care unit (ICU) LOS, escalation of respiratory support, increased level of care (LOC), and incidence of delirium tremens and/or seizures.

Results: Two hundred and seventy-seven patients received lorazepam and 198 received phenobarbital. Hospital LOS was longer in the phenobarbital cohort compared with the lorazepam cohort (6.9 vs 9.3 days). There was no difference in ICU LOS. Level of care increases were fewer in the phenobarbital cohort (4 events vs 19 events). There were higher rates of non-invasive respiratory interventions in the lorazepam cohort and higher rates of mechanical ventilation in the phenobarbital cohort. Utilization of phenobarbital was attributed to a reduction in delirium tremens and seizures.

Conclusion and relevance: This study is novel because of the broad application of a phenobarbital order set across multiple levels of care and patient admission diagnoses. A risk targeted split load intravenous phenobarbital order set can safely be administered to patients with fewer escalations of care, seizures, delirium tremens, and respiratory care escalation.

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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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