Colossum Kraljevo

It is important to note that the implementation of the PB-based protocol in our hospital occurred during the COVID-19 pandemic, which may have had Substance abuse an impact on our results due to the potential for selection bias. Our hospital is part of a larger healthcare system, and cases were redirected to other facilities based on MICU availability, which could have affected the results. Finally, the use of CIWA-Ar in the MICU has been subject to debate in the literature, as it relies on patient cooperation (27).

Medical

Further, the intramuscular route and relatively low doses of phenobarbital used in this study provide a pathway for usage beyond the ICU setting in hospital wards. However, additional studies are needed to test the safety of this protocol in the hospital ward setting. We also collected initial AWS symptoms at MICU admission and the CIWA-Ar score at MICU admission, during the stay and at discharge from MICU. However, it does not seem to have an impact when it comes to the length of ICU stay and the risk for intubation. Since some vital details are lacking in the included studies, it is important to mention the need for large-scale, multi-center studies to be conducted before solid conclusions and recommendations can be made. Another important chapter that is missing from the previous studies is the safety of phenobarbital and the uniformity of dosing.

Associated Data

• If you have AUD and suddenly stop consuming alcohol, your brain receptors are not prepared for this change.
• Additionally, adverse effects such as bradycardia, hypotension, and mortality were examined.
• The low number of GABA receptors and high number of glutamate receptors make your brain overly sensitive to stimulation.
• An analysis of the descriptive data was conducted using SPSS Statistics, version 26 (IBM Corp., Armonk, NY).

Your recovery team will discuss the benefits and risks with you whether they feel it’s necessary for your long-term health. During your recovery, your prescribed phenobarbital dose will gradually decrease over time to prevent phenobarbital withdrawal symptoms, such as anxiety, muscle twitches, and seizures. According to a 2022 systematic review, severe cutting back on alcohol symptoms AWS symptoms, such as seizures and delirium, occurred in around 20% of people with AWS. A protocol utilizing rapidly escalating doses of PB over a short period is an effective and safe alternative to BZD in treating AWS in MICU.

Figure 3.

Risk factors for respiratory compromise included pneumonia; chronic obstructive pulmonary disease (COPD); asthma; interstitial lung disease; or pulmonary fibrosis. If patients had one of the above risk factors; then the protocol would recommend the lower loading dose of phenobarbital; 6 mg/kg. Phenobarbital, a long‐acting barbiturate, presents an alternative to conventional benzodiazepine treatment for alcohol withdrawal syndrome (AWS). Currently, existing research offers only modest guidance on the safety and effectiveness of phenobarbital in managing AWS in hospital settings. The study objective was to assess if a phenobarbital protocol for the treatment of AWS reduces respiratory complications when compared to a more traditionally used benzodiazepine protocol.

• In the United States, alcohol abuse represents a significant healthcare burden, with over 14 million Americans suffering from alcohol use disorder.
• A patient with alcohol use disorder has low levels of GABA, causing benzodiazepines to fail to produce the desired response, resulting in resistant alcohol withdrawal syndrome, characterized by hallucinations, seizures, and delirium tremens 3-5.
• Our study concludes that phenobarbital is an effective tool in the management of AWS in an ICU setting.
• The analysis was limited by the fact that a few critical parameters, such as hospital stay, were reported in only three studies, making it difficult to reach meaningful conclusions.
• Kaplan-Meier curves showing the probability of (A) ICU and (B) hospital discharge over time.
• Alcohol withdrawal syndrome (AWS) can occur when you stop or limit alcohol use after a period of prolonged and heavy use.

In contrast, Goodberlet et al. reported the opposite findings showing more prolonged hospitalization in the phenobarbital group compared to benzodiazepine 13. The medication has a wide margin of safety when used for sedative‐hypnotic withdrawal. The doses that are efficacious for treating withdrawal symptoms do not produce significant CNS depression. Phenobarbital has a rapid onset of action, so monitoring the clinical effects of phenobarbital loading doses is practical.

The low number of GABA receptors and high number of glutamate receptors make your brain overly sensitive to stimulation. If you engage in excessive, long-term alcohol consumption, your brain tries to counteract the depressant effect of the alcohol. It does this by reducing the number of GABA receptors and increasing the number of glutamate receptors.

Figure 1.

• The review adds that these seizures can occur in the absence of other AWS signs and symptoms.
• A 2023 research review lists seizures as a common complication of AWS, noting that alcohol withdrawal seizures typically occur between 8 and 48 hours after quitting alcohol.
• Ultimately, nine studies were included in this systematic review and meta-analysis after 12 papers were excluded from the full-text screening phase (Figure 1).
• Parenteral phenobarbital loading doses with an oral phenobarbital tapered protocol for AWS resulted in decreased risk of respiratory complications when compared to standard treatment with benzodiazepines.
• Patients initially experience nausea, sweating, headaches, shakiness, tachycardia and hypertension.

Several observational studies have been published on the effectiveness of phenobarbital in AWS, with mixed results. As a result, we conducted our meta-analysis in order to assess phenobarbital’s effectiveness in AWS. Duby et al. conducted a retrospective study where patients in the preintervention group (PRE) were treated in a non-protocolized fashion and typically received continuous infusions or scheduled doses of benzodiazepines according to physician preferences. The AWS protocol was used to administer escalating diazepam and phenobarbital to patients in the postintervention group (POST) 16.

4. Statistical analysis

The limitations of these studies include the inability to control the acquisition of the desired data, which may lead to the loss of essential details. The study by Shah et al. showed that front-loaded phenobarbital participants experienced significantly fewer episodes of hypotension than those receiving low intermittent dosing of phenobarbital 15. As reported by Goodberlet et al., there was no difference in mortality between the two arms 13. Contrary to this, Duby et al. reported improved mortality outcomes in patients treated with phenobarbital 16. Additionally, phenobarbital used for epilepsy is easily measurable, giving it an advantage over benzodiazepines.