Evaluation of Symptom-Triggered Benzodiazepines Versus Phenobarbital for Alcohol Withdrawal Syndrome in Trauma-Surgical Intensive Care Patients.

This article focuses on comparing a preemptive phenobarbital monotherapy protocol to symptom-triggered benzodiazepines for the prevention or treatment of alcohol withdrawal syndrome (AWS) in trauma-surgical critical care patients. In a retrospective single-center study of 200 patients, phenobarbital use was associated with similar intensive care unit (ICU) and hospital length of stay compared to benzodiazepines but demonstrated significantly lower hospital and ICU mortality, reduced need for mechanical ventilation, and decreased use of adjunctive sedative agents. The phenobarbital protocol utilized the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) for risk stratification and included fixed dosing with as-needed breakthrough doses guided by the Richmond Agitation Sedation Scale (RASS). While the study supports phenobarbital as a potentially safer and effective alternative to benzodiazepines in this population, limitations include its retrospective design, single-center setting, and incomplete data on withdrawal complications and severity, highlighting the need for further research on optimal dosing strategies.