AWS can include seizures, hallucinations, delirium, and/or autonomic instability. We assessed the quality of the included studies using the risk-of-bias assessment tool developed by the National Institutes of Health (NIH) 9. An analysis of the descriptive data was conducted using SPSS Statistics, version 26 (IBM Corp., Armonk, NY).
PATIENTS:
- We found that the majority of the studies included in our study included patients with a prior history of AWS, polysubstance abuse, and alcohol withdrawal seizures 10,12-17.
- Compared to benzodiazepine administration for AWS, phenobarbital may help to reduce respiratory complications.
- Both Tidwell et al. and Saukkonen et al. found that phenobarbital treatment reduced hospital stay in both arms.
- Reduced sedation needs may be responsible for the lower incidence of intubations, as previously reported 13-18.
This syndrome happens because of alcohol-induced changes to the brain’s neurochemistry over time. The data that support the findings of this study are openly available as an Appendix S1. This section collects any data citations, cutting back on alcohol symptoms data availability statements, or supplementary materials included in this article.
How we reviewed this article:
Our study highlights that PB-based protocols achieve clinical effectiveness in treating AWS with few side effects. Continuous assessment of the currently implemented protocol is required to monitor if the benefit would be retained over Halfway house time. The first study cohort included patients who initiated the phenobarbital protocol from December 2017 to January 2019.
- The management protocols implemented for the treatment of AWS in an ICU setting in both control and experimental groups have been described in depth in Table 2.
- Potential limitations of this study include the retrospective design, the concurrent dexmedetomidine shortage, and medication crossover.
- Risk factors for sedation included age of 65 or older; hepatic dysfunction; or cirrhosis.
- As reported by Goodberlet et al., there was no difference in mortality between the two arms 13.
- Benzodiazepines are fully effective when GABA is available at the receptor site.
Implementation of the Phenobarbital Protocol
After removing duplicate records and manually screening abstracts and titles, 21 records were identified for further full-text screening. Two studies were excluded due to the data being individualized for every patient and lack of mean/median values of the variables examined for the entire study population. 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). The National Institute on Alcohol Abuse and Alcoholism (NIAAA)9 reports that approximately 16 million people in the United States have AUD and are therefore at increased risk of developing AWS. AWS can occur as early as 6 h and may persist for up to 7 days after alcohol cessation.
Figure 4. Funnel plot of the length of ICU stay for the phenobarbital vs. control group.
A few participants in the case series conducted by Ammar et al. received quetiapine, haloperidol, or a combination of the two for the management of alcohol withdrawal syndrome 10. Patients requiring mechanical ventilation in the study conducted by Gold et al. received propofol 17. Goodberlet et al. conducted a study where a few of the participants in both control and experimental arms received dexmedetomidine, clonidine, propofol, and antipsychotics 13. A total of 11 patients in the experimental group and 26 patients in the control group received propofol and dexmedetomidine for the management of alcohol withdrawal syndrome in the study conducted by Saukkonen et al. 18.
