IN hospitalized patients with alcohol withdrawal syndrome (AWS), early addition of phenobarbital to lorazepam-based treatment significantly reduces the length of stay and the need for mechanical ventilation compared to dexmedetomidine, according to a new retrospective study conducted in a U.S. tertiary hospital.
The study analyzed outcomes for 156 adult patients hospitalized with AWS between May 2018 and July 2021. Patients were divided into two cohorts: those treated with dexmedetomidine and lorazepam (DEX, n=102), and those treated with phenobarbital and lorazepam (PHENO, n=54). Physicians determined which adjunctive therapy to use based on clinical judgment.
Patients in the phenobarbital group had a 67% lower likelihood of intubation (odds ratio 0.33, p=0.005), shorter hospital stays (incidence rate ratio [IRR] 0.45, p<0.001), and reduced ICU stays (IRR 0.58, p=0.050) compared with those in the dexmedetomidine group. The benefits of phenobarbital were most pronounced when used alongside lower doses of lorazepam (<3 mg). However, as lorazepam doses increased, the protective effects of phenobarbital diminished. For each additional milligram of lorazepam administered, hospital stay lengthened by 10% (IRR 1.10, p<0.001), and ICU stay extended by 6% (IRR 1.06, p=0.074). These findings suggest that early intervention with phenobarbital, when combined with a symptom-triggered lorazepam regimen, may optimize care for patients with severe AWS and help reduce ICU resource burden.
