(1770) Evaluation of Benzodiazepines Versus Phenobarbital for Alcohol Withdrawal Syndrome in TSICU Patients

Introduction: At time of injury, up to 40% of trauma patients are estimated to misuse alcohol. Currently, the standard of care for alcohol withdrawal syndrome (AWS) is symptom triggered benzodiazepines. Benzodiazepines have known risks with development of delirium and respiratory depression. There is a renewed interest in utilizing phenobarbital first line for AWS in trauma surgical patients. The purpose of this study was to compare outcomes of an institution specific proactive phenobarbital monotherapy protocol compared to symptom triggered benzodiazepines for the prevention or treatment of AWS in the trauma surgical patients.

Methods: This was a single center, retrospective, quasi-experimental study to evaluate the change in AWS standard of care for the Trauma Surgical Critical Care Service. Patients were divided into groups based on AWS protocol used. The primary outcome was ICU length of stay (LOS). Secondary outcomes included: mortality, hospital LOS, use of adjunctive agents for sedation, and incidence of mechanical ventilation rates after protocol initiation.

Results: Overall, 200 patients were included with 100 patients in each group. Patients who received the phenobarbital protocol had similar ICU LOS (median [IQR], 2.6 days [1.4 days-5.6 days] vs 2.9 days [1.8 days-4.7 days]; p=0.04) and hospital LOS (8.1 days [3.9 days-16.9 days] vs 7.1 days [3.9 days-11.2 days]; p=0.05). All cause hospital mortality was significantly lower in those who received phenobarbital (4% vs 14%; p =0.02), as was use of adjunctive sedative agents (22% vs 46%; p < 0.001), and mechanical ventilation rates (9% vs 31%; p < 0.001) when compared to symptom triggered benzodiazepines.

Conclusions: Trauma surgical patients managed with phenobarbital for prevention or treatment of AWS had similar ICU and hospital lengths of stay compared to symptom triggered benzodiazepines. The use of a phenobarbital monotherapy protocol was associated with lower mortality, mechanical ventilation, and adjunctive sedative medication use.