BACKGROUND:Acute alcohol withdrawal syndrome (AAWS) is encountered in patients presenting acutely to the Emergency Department (ED) and often requires pharmacologic management. OBJECTIVE: We investigated whether a single dose of intravenous (i.v.) phenobarbital combined with a standardized lorazepam-based alcohol withdrawal protocol decreases intensive care unit (ICU) admission in ED patients with acute alcohol withdrawal. METHODS: This was a prospective, randomized, double-blind, placebo-controlled study. Patients were randomized to receive either a single dose of i.v. phenobarbital (10 mg/kg in 100 mL normal saline) or placebo (100 mL normal saline). All patients were placed on the institutional symptom-guided lorazepam-based alcohol withdrawal protocol. The primary outcome was initial level of hospital admission (ICU vs. telemetry vs. floor ward). RESULTS: There were 198 patients enrolled in the study, and 102 met inclusion criteria for analysis. Fifty-one patients received phenobarbital and 51 received placebo. Baseline characteristics and severity were similar in both groups. Patients that received phenobarbital had fewer ICU admissions (8% vs. 25%, 95% confidence interval 4-32). There were no differences in adverse events. CONCLUSIONS: A single dose of i.v. phenobarbital combined with a symptom-guided lorazepam-based alcohol withdrawal protocol resulted in decreased ICU admission and did not cause increased adverse outcomes.
RCT Entities:
BACKGROUND: Acute alcohol withdrawal syndrome (AAWS) is encountered in patients presenting acutely to the Emergency Department (ED) and often requires pharmacologic management. OBJECTIVE: We investigated whether a single dose of intravenous (i.v.) phenobarbital combined with a standardized lorazepam-based alcohol withdrawal protocol decreases intensive care unit (ICU) admission in ED patients with acute alcohol withdrawal. METHODS: This was a prospective, randomized, double-blind, placebo-controlled study. Patients were randomized to receive either a single dose of i.v. phenobarbital (10 mg/kg in 100 mL normal saline) or placebo (100 mL normal saline). All patients were placed on the institutional symptom-guided lorazepam-based alcohol withdrawal protocol. The primary outcome was initial level of hospital admission (ICU vs. telemetry vs. floor ward). RESULTS: There were 198 patients enrolled in the study, and 102 met inclusion criteria for analysis. Fifty-one patients received phenobarbital and 51 received placebo. Baseline characteristics and severity were similar in both groups. Patients that received phenobarbital had fewer ICU admissions (8% vs. 25%, 95% confidence interval 4-32). There were no differences in adverse events. CONCLUSIONS: A single dose of i.v. phenobarbital combined with a symptom-guided lorazepam-based alcohol withdrawal protocol resulted in decreased ICU admission and did not cause increased adverse outcomes.
Authors: Fadi Hawa; Linsey Gilbert; Benjamin Gilbert; Vanessa Hereford; Aya Hawa; Alsadiq Al Hillan; Mark Weiner; Jeremy Albright; Caleb Scheidel; Ola Al-Sous Journal: Cureus Date: 2021-02-11
Authors: S Jesse; G Bråthen; M Ferrara; M Keindl; E Ben-Menachem; R Tanasescu; E Brodtkorb; M Hillbom; M A Leone; A C Ludolph Journal: Acta Neurol Scand Date: 2016-09-01 Impact factor: 3.209
Authors: Niall Filewod; Stephen Hwang; Christian J Turner; Leena Rizvi; Sara Gray; Michelle Klaiman; Danielle Buell; Johnathan Ailon; Alexander Caudarella; Galo F Ginocchio; Marlene Santos; Gyan Sandhu; Norman Dewhurst; Kelly Sequeira; Karen E A Burns Journal: Pilot Feasibility Stud Date: 2022-01-22