(121) Addition of Phenobarbital to the MINDS Protocol for Patients With Acute AWS in the ICU

Introduction: There is minimal data evaluating phenobarbital use within the Minnesota Detoxification Scale (MINDS) protocol. This study aims to determine if adjunctive phenobarbital to the MINDS protocol shows clinical benefit in alcohol withdrawal syndrome (AWS), to mitigate symptoms and possibly decrease adverse outcomes.

Methods: A single-center, retrospective cohort study was conducted from January 1st, 2019, to January 1st, 2022, to assess the addition of phenobarbital to the intensive care unit (ICU) MINDS protocol. Patients >18 years old treated with the MINDS protocol for AWS in the ICU were included. The primary endpoint was ICU length of stay (LOS). Secondary endpoints included incidence and duration of mechanical ventilation, benzodiazepine utilization, transfer rate back to the ICU, readmission rates, in-hospital mortality, medication utilization, and incidence of complications (aspiration, seizure, delirium tremens [DT], oversedation).

Results: The phenobarbital group (n=126) was more likely to have a prior hospitalization with alcohol withdrawal (p=0.007), history of seizures (p=0.043), history of DT (p=0.002), and home benzodiazepine use (p=0.012) compared to the non-phenobarbital group (n=127). Median ICU length of stay was shorter in the non-phenobarbital group (1.84 days vs 3.23 days, p< 0.001). Incidence and duration of ventilation were similar between cohorts (p=0.068 and p=0.172, respectively). The phenobarbital group received significantly more midazolam over a longer period according to several outcome measures. ICU readmission within the same encounter (p=0.264), 30-day readmission (p=0.689), and in-hospital mortality (p=0.122) were similar between groups. Complications of aspiration and DT occurred more frequently in the phenobarbital group (p=0.001 and p< 0.001), while seizure occurrence was similar between groups (p=0.922).

Conclusions: Patients in the phenobarbital group received more midazolam and had longer ICU stays than non-phenobarbital patients. However, patients in the phenobarbital group had more risk-factors for severe withdrawal than their non-phenobarbital counterparts. Despite this, ventilation duration and 30-day readmission were similar between groups. Future research should account for differences in baseline characteristics of comparator groups.