(1025) Evaluation of a Phenobarbital Protocol in Surgical Trauma ICU Patients With Alcohol Withdrawal

Introduction: Patients with alcohol abuse admitted to the ICU have 2-3 times increased risk of morbidity, higher rates of complications, longer hospital stay and worse outcomes. Phenobarbital may decrease intensive care unit and hospital length of stay, decrease intubation needs, and require less adjunctive therapy. This study compared protocols of lorazepam CIWA vs phenobarbital plus lorazepam CIWA for alcohol withdrawal.

Methods: This retrospective, IRB-approved, cohort study evaluated trauma ICU patients at a level II trauma center who received lorazepam 1-4 mg IV/PO Q1H as needed based on CIWA score vs three regimens of phenobarbital for alcohol withdrawal syndrome plus lorazepam CIWA. Active delirium tremens (DTs) 260 mg IV x 1 dose, 97.2 mg TID x 6 doses, then 64.8 mg TID x 6 doses, then 32.4 mg TID x 6 doses; for history of DTs 97.2 mg TID x 6 doses, 64.8 mg TID x 6 doses, 32.4 mg TID x 6 doses and or no history of DTs 64.8 mg TID x 6 doses, then 32.4 mg TID x 6 doses. Patients included were ≥18 years old, had a diagnosis of alcohol withdrawal syndrome and received one of the phenobarbital regimens + lorazepam CIWA or lorazepam CIWA. Data was collected from June 1, 2020-June 30, 2022. The primary outcome assessed readmissions to the ICU. Secondary outcomes included duration of intubation, hospital and ICU length of stay (LOS), and adverse events of hypotension and tachycardia. Statistical analysis included Fisher’s Exact test for categorical variables and Kruskal-Wallis or ANOVA for numerical variables.

Results: We included 50 patients in CIWA and 90 patients in phenobarbital cohort. Readmissions to the ICU, 6 (12%) in CIWA and 2 (2.2%) in phenobarbital, p=0.025. Duration of intubation 1.97 [1.18,7/03] in CIWA and 3.02 [1.33,8.18] in phenobarbital, p=0.61. ICU LOS 3.73 [1.78,8.49] in CIWA and 2.27 [1.18,6.21] in phenobarbital, p=0.6. Hospital LOS 15.41 [8.93, 30.64] in CIWA and 9.21 [4.99, 21.72] in phenobarbital, p=0.005. Hypotension 35 (70%) in CIWA and 17 (19.8%) in phenobarbital, p= < 0.001. Tachycardia 38 (76%) in CIWA and 38 (43.7%) in phenobarbital, p= < 0.001.

Conclusions: The results of this study demonstrate that phenobarbital may prevent readmissions to the ICU, decrease hospital LOS, as well as decrease hypotension and tachycardia while undergoing treatment for alcohol withdrawal.