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"Should We Phenobarb-it-All?" A Phenobarbital-Based Protocol for Non-Intensive Care Unit Trauma Patients at High Risk of or Experiencing Alcohol Withdrawal.
Wang, Michelle; Falank, Carolyne; Simboli, Vincent; Ontengco, Julianne B; Spurling, Brandi; Rappold, Joseph; Chung, Bruce; Smith, Kathryn E.
Afiliación
  • Wang M; Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA.
  • Falank C; Department of Surgery, Maine Medical Center, Portland, ME, USA.
  • Simboli V; Department of Pharmacy, Maine Medical Center, Portland, ME, USA.
  • Ontengco JB; Department of Surgery, Maine Medical Center, Portland, ME, USA.
  • Spurling B; Department of Surgery, Maine Medical Center, Portland, ME, USA.
  • Rappold J; Department of Surgery, Maine Medical Center, Portland, ME, USA.
  • Chung B; Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
  • Smith KE; Department of Pharmacy, Maine Medical Center, Portland, ME, USA.
Am Surg ; 90(6): 1531-1539, 2024 Jun.
Article en En | MEDLINE | ID: mdl-38574377
ABSTRACT

BACKGROUND:

Alcohol use is frequent in trauma patients and alcohol withdrawal syndrome (AWS) is associated with significant morbidity. Benzodiazepines are commonly used for AWS, but may cause neurologic and respiratory adverse events (AEs). The objective was to evaluate the effectiveness and safety of a phenobarbital-based protocol for the treatment of AWS in non-intensive care unit (ICU) trauma patients.

METHODS:

Adult non-ICU trauma patients at high risk of or experiencing AWS PRE and POST implementation of a phenobarbital-based protocol were included. Outcomes were AWS-related complications (AWS-RC), benzodiazepine use, adjunctive medication use, hospital length of stay (HLOS), and medication-related AEs. Subgroup analyses were performed on patients with traumatic brain injury (TBI), rib fractures, and at high risk of severe AWS.

RESULTS:

Overall, 110 patients were included (51 PRE, 59 POST). AWS-RC developed in 17 PRE patients compared to 10 POST patients (33% vs 17%; P = .05). PRE patients were more likely to receive benzodiazepines (88% vs 42%, P < .0001) and higher total dose (11 vs 4 mg lorazepam equivalent; P = .001). No difference noted in HLOS (8 vs 8 days, P = .27), adjunctive medication use (49% vs 54%, P = .60), or AEs (57% vs 39%, P = .06). There was no difference in AWS-RC in the TBI subgroup (P = .19), less AEs in the rib fracture POST subgroup (P = .04), and less AWS-RC in the high risk of severe AWS POST subgroup (P = .03).

DISCUSSION:

A phenobarbital-based protocol in trauma patients is effective in preventing AWS-RC and decreasing benzodiazepine use without increasing AEs.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fenobarbital / Benzodiazepinas / Protocolos Clínicos Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Am Surg Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fenobarbital / Benzodiazepinas / Protocolos Clínicos Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Am Surg Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos