Name: Evaluation of a Critical Care Phenobarbital Protocol for Alcohol Withdrawal Management
Start: 2026-05-18T13:10:00-0400
End: 2026-05-18T13:30:00-0400

Evaluation of a Critical Care Phenobarbital Protocol for Alcohol Withdrawal Management

Monday May 18, 2026 1:10pm - 1:30pm EDT

a.Pavilion Hub EAST

To evaluate the safety and effectiveness of a standardized phenobarbital protocol for alcohol withdrawal syndrome in a mixed ICU at a community hospital compared to benzodiazepine based management.

This retrospective cohort study evaluated adults admitted to a mixed ICU at a community hospital with alcohol withdrawal (AWS) between May–November 2024 and May–November 2025. Adults with a diagnosis of AWS and critical care admission who received phenobarbital through a standardized weight-based protocol, or benzodiazepines through the medical AWS order set were included. Exclusion criteria consisted of mechanical ventilation before medication initiation, use of phenobarbital or benzodiazepines prior to admission based on the home medication list or dispense history, or benzodiazepine-treated patients who received phenobarbital. The primary outcome was incidence of escalation to continuous sedation or intubation within 72 hours, with secondary outcomes assessing safety, medication use, symptom control, adjunctive sedative use, and length of stay (LOS).

Of 230 patients reviewed, 170 met inclusion criteria (phenobarbital n=90; benzodiazepine n=80). The primary outcome occurred in 18 phenobarbital patients and 24 benzodiazepine patients. Phenobarbital was associated with lower odds of escalation (20% vs 32.5%); however, this was not statistically significant (OR 0.59, 95% CI 0.29–1.19; p=0.14). Median ICU LOS (2.1 vs 2.9 days; p=0.008), hospital LOS (4 vs 5 days; p=0.032), and as needed benzodiazepine use (1 vs 38.5 milligrams; p≤0.001) were significantly lower with phenobarbital. Adverse respiratory events were more frequent with phenobarbital (13.3% vs 0%; p≤0.001), while seizures (1.1% vs 10%; p=0.013) and delirium tremens (0% vs 83.8%; p≤0.001) were more frequent with benzodiazepines.

Although the primary outcome was not statistically significant, the findings suggest potential clinical benefit. A standardized phenobarbital protocol was associated with reduced ICU and hospital LOS and decreased incidence of seizure and delirium tremens when compared to benzodiazepine based management. Further studies with larger populations are needed to confirm these findings.

Moderators

Danielle Schulingkamp

Melissa Tu, PharmD, BCPS

Benjamin Wilkinson, PharmD, BCCCP

Speakers

Annabel La

PGY1, Penn Medicine Lancaster General Hospital

I was born and raised in New Jersey and recently earned my PharmD and MBA from the University of Rhode Island in spring 2025. My clinical interests are centered in ambulatory care, and I’m excited to continue at PMLGH as a PGY2 resident in this specialty. Outside of pharmacy, I... Read More →

Monday May 18, 2026 1:10pm - 1:30pm EDT
a.Pavilion Hub EAST

Critical Care

PSHP 2026 Residency Conference

Danielle Schulingkamp

Melissa Tu, PharmD, BCPS

Benjamin Wilkinson, PharmD, BCCCP

Annabel La

Attendees (20)

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PSHP 2026 Residency Conference

Danielle Schulingkamp

Melissa Tu, PharmD, BCPS

Benjamin Wilkinson, PharmD, BCCCP

Annabel La

Attendees (20)

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