Phenobarbital Addition to Alcohol Withdrawal Treatment Offers Better Outcomes than Dexmedetomidine in Hospitalized Patients

Authors

Mary Matecki, George Washington University, Department of Surgery, Center for Trauma and Critical Care, Washington, DC, USA.
Ahmed Noureldin, George Washington University, Department of Surgery, Center for Trauma and Critical Care, Washington, DC, USA.
Riad Akkari, George Washington University, Department of Anesthesiology and Critical Care Medicine, Washington, DC, USA.
Zachary Cohen, George Washington University, School of Medicine and Health Sciences, School of Medicine, Washington, DC, USA.
Matthew McMullan, George Washington University, Department of Anesthesiology and Critical Care Medicine, Washington, DC, USA.
Katrina Hawkins, George Washington University, Department of Anesthesiology and Critical Care Medicine, Washington, DC, USA.
Jeffrey Williams, George Washington University, Department of Anesthesiology and Critical Care Medicine, Washington, DC, USA.
Azuka Nwude, George Washington University Hospital, Pharmacy, Washington, DC, USA.
David Yamane, George Washington University, Department of Anesthesiology and Critical Care Medicine, Washington, DC, USA.
Babak Sarani, George Washington University, Department of Surgery, Center for Trauma and Critical Care, Washington, DC, USA.
Sean M. Lee, George Washington University, School of Medicine and Health Sciences, School of Medicine, Washington, DC, USA.
Susan Kartiko, George Washington University, Department of Surgery, Center for Trauma and Critical Care, Washington, DC, USA.

Document Type

Journal Article

Publication Date

3-28-2025

Journal

Journal of intensive care medicine

DOI

10.1177/08850666251328881

Keywords

CIWA-AR; alcohol withdrawal; benzodiazepines; delirium tremens; dexmedetomidine; phenobarbital

Abstract

BackgroundThis study directly compares outcomes of phenobarbital and dexmedetomidine as adjuncts to symptom-triggered benzodiazepine treatment for alcohol withdrawal syndrome (AWS).MethodsThis is a retrospective cohort analysis at a single tertiary referral institution in a major urban center in the United States. In hospitalized patients above 18 years with AWS between May 1, 2018, and July 31, 2021 we compared the hospital length of stay (LOS), ICU LOS, mechanical ventilation incidence and duration of patients who received dexmedetomidine versus phenobarbital as adjuncts to lorazepam-based treatment. Patients were divided into two cohorts based on treatment they received - dexmedetomidine/lorazepam (DEX) versus phenobarbital/lorazepam (PHENO). The use of phenobarbital or dexmedetomidine was left to the discretion of the treating bedside physician.ResultsOne hundred fifty-six patients met inclusion criteria with 102 patients (65%) in the DEX group and 54 patients (35%) in the PHENO group. The PHENO group had a lower probability of intubation (OR 0.33, 95% CI 0.15-0.70, p = 0.005) and shorter hospital LOS (IRR 0.45, 95% CI 0.31-0.64, p < 0.001), and ICU LOS (IRR 0.58, 95% CI 0.34-1.00, p = 0.050). For both hospital and ICU LOS, the PHENO group had shorter LOS than dexmedetomidine at lower doses of lorazepam (<3 mg), but this protective effect diminished at higher doses of lorazepam, at a rate of 10% (hospital LOS, IRR 1.10, 95% CI 1.05-1.16, p < 0.001) and 6% (ICU LOS, IRR 1.06, 95% CI 0.99-1.13, p = 0.074) per milligram increase in lorazepam.ConclusionsA symptom- triggered lorazepam regimen including early phenobarbital administration for severe alcohol withdrawal syndrome is associated with lower hospital LOS and need for intubation compared to a symptom triggered lorazepam regimen with dexmedetomidine adjunct.

APA Citation

Matecki, Mary; Noureldin, Ahmed; Akkari, Riad; Cohen, Zachary; McMullan, Matthew; Hawkins, Katrina; Williams, Jeffrey; Nwude, Azuka; Yamane, David; Sarani, Babak; Lee, Sean M.; and Kartiko, Susan, "Phenobarbital Addition to Alcohol Withdrawal Treatment Offers Better Outcomes than Dexmedetomidine in Hospitalized Patients" (2025). GW Authored Works. Paper 6749.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6749

Department

School of Medicine and Health Sciences Resident Works